ACCEPTABILITY OF ALTERNATIVE TREATMENTS FOR DEVIANT CHILD BEHAVIOR

The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were applied to children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance.     

Acceptability of positive and reductive behavioral interventions: Factors that influence teachers'' decisions

Treatment acceptability refers to individuals' judgments as to whether psychological treatment procedures are appropriate, fair, and reasonable for a given problem. In the present two-experiment study, experienced teachers' ratings of acceptability for positive (i.e., praise, home-based reinforcement, and token economy) and reductive (i.e., ignoring, response-cost lottery, and seclusion time-out) behavioral interventions were investigated. Using the Intervention Rating Profile (IRP) and a case study methodology to manipulate variables of intervention complexity and problem behavior severity, it was established that (a) teachers' acceptability ratings of both positive and reductive interventions varied with the severity of a target behavior, (b) the complexity of an intervention influenced teachers' ratings of acceptability, less complex or time-consuming interventions being rated generally more acceptable, and (c) mean acceptability ratings were significantly more favorable for positive than reductive treatments. These findings are discussed in the context of previous acceptability research and future investigations.     

Acceptability of aversive procedures and medication as treatment alternatives for deviant child behavior

The present investigation evaluated the acceptability of alternative treatments for deviant child behavior. Clinical cases of children who displayed severe behavioral problems at home and at school were described along with three different treatments. The treatments, time-out from reinforcement, locked seclusion, and medication, were rated by psychiatric inpatient children and parents in a 3 × 3 replicated Latin-square design. The investigation also evaluated whether acceptability ratings were influenced by the clinical effectiveness of treatment in altering behavior. Although children and parents did not differ overall in acceptability ratings, they differed in their ranking of different treatments. Children viewed medication as the most acceptable treatment, whereas parents viewed time out as the most acceptable treatment. For both children and parents, treatments described as producing marked effects were rated as more acceptable than treatments producing weaker effects. The results indicated that disturbed children and their parents can readily distinguish the acceptability of alternative treatments. The implications of treatment acceptability for clinical applications of treatment are discussed.Completion of this investigation was facilitated by a Research Scientist Development Award (MH00353) and a grant (MH35408) from the National Institute of Mental Health. The author is grateful for the assistance of the clinical research team of the Child Psychiatric Treatment Service, especially that of Irene Heidish, M.A., who assisted with the data analyses.     

Acceptability of Time Out from Reinforcement Procedures for Disruptive Child Behavior:

Forty-eight teachers and forty-eight parents evaluated the effectiveness and acceptability of five behavioral procedures for reducing disruptive behavior in children. The results showed that teachers evaluated the procedures as being more effective and acceptable than did the parents. The treatment procedures rated as most effective and acceptable were reinforcement and isolation and contractual agreement. In additon, the procedures were rated as being more effective and acceptable for 5-year-olds than for 10-year-olds. The results of this study are compared to similiar studies reported by Kazdin.     

The Relationship Between Child Behavior and Acceptability of Contingency Management Procedures

Relationships between maternal ratings of treatment acceptability and three predictor variables, change in child noncompliance during treatment, disruptive child behavior associated with treatment procedures, and severity of child behavior problems, were examined in the context of a brief parent training program. Stepwise multiple regression analysis indicated that amount of disruptive behavior and change in child noncompliance were significant predictors of treatment acceptability, with those treatments which produced less disruptive behavior and greater reductions in noncompliance being rated as more acceptable. The combination of these two variables accounted for nearly 40% of the variance in acceptability ratings. These results are discussed in relation to previous findings with treatment analogues.     

Parents' perceptions of pharmacological and cognitive-behavioral treatments for childhood anxiety disorders

Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for childhood anxiety disorders. This study examined how parents (N=71) seeking treatment for their child's anxiety disorder perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable, believable, and effective in the short- and long-term. Children's treatment history influenced parents' perceptions of pharmacotherapy, with parents of children with no treatment history perceiving medication treatment as less acceptable and believable than parents of children with a history of medication alone or in combination with behavior therapy. No effect of treatment history was found for perceptions of CBT. Significant positive correlations emerged between parents' perceived acceptance and believability for pharmacotherapy and child age and level of dysfunction due to their child's anxiety, respectively. The level of the child's anxiety was not significantly correlated with parents' perceptions of either CBT or pharmacotherapy. Our results suggest that parents of anxious children prefer CBT to medication for the treatment of their child's anxiety disorder. Directions for future research are discussed.     

Consumers' and clients' pretreatment acceptability ratings of classroom group contingencies

Group contingencies are popular with teachers and have been demonstrated to be effective for managing children's classroom behavior. Children's views of the acceptability of such techniques, however, have not been assessed systematically and may have important consequences for long-term treatment effectiveness. In addition, little is known about psychologists' sense of the acceptability of such techniques. The present analog study investigated fifth graders', teachers', and school psychologists' assessment of the acceptability of three types of group contingencies (dependent, independent, and interdependent) that entail a consequence of positive reinforcement for appropriate behavior. Variables of treatment type, sex of rater, and the severity of a hypothetical classroom problem were examined to determine their influence on intervention acceptability scores on a child's and an adult's version of the Intervention Rating Profile. Fifth graders rated all three types of group contingencies mildly acceptable. Teachers and school psychologists rated the dependent form of the group contingency unacceptable, and the independent and interdependent forms acceptable.     

Perceptions of the acceptability of parent training among Chinese immigrant parents: contributions of cultural factors and clinical need

Parent training (PT) is well established for reducing child externalizing problems; however, lower rates of engagement in PT among ethnic minority/immigrant families have been found. We assessed PT acceptability among Chinese immigrant parents and explored clinical and cultural factors that may be associated with acceptability. Participants were a community sample of 145 Chinese immigrant parents (84% mothers) between the ages of 32 and 65 years (M=43.3 years, SD=6.2) who had children (84 boys, 59 girls) between the ages of 4 and 17 years (M=10.7 years, SD=3.6). Results suggest that parents found positive reinforcement techniques significantly more acceptable, less problematic, and more likely to be supported by others than punishment-based techniques. Parents who endorsed the Chinese child-rearing value of shaming were less likely to find PT acceptable. Parents who reported greater dysfunction in parent-child interactions rated PT as more acceptable, and families with prior Child Protective Services (CPS) involvement rated PT as less acceptable. However, previous mental health treatment appears to bolster acceptability among parents with prior CPS involvement. Clinical implications for addressing barriers to PT engagement and future research directions are discussed.     

Acceptability of behavioral interventions: Perceptions of superintendents of public residential facilities

The acceptability of behavioral procedures has been examined with many groups of individuals that have significant roles in the lives of persons with mental retardation. However, for those individuals that live in public residential facilities, one critical person in the decision making process is the superintendent. The purpose of this study was to assess the acceptability of treatments to superintendents of public residential facilities. Using the Treatment Evaluation Inventory (Kazdin, 1980), superintendents rated the acceptability of five treatments (DRO, Time-out, medication, overcorrection and contingent shock) applied to a mild and severe behavior problem. The results showed a significant main effect for treatment and problem and a problem by treatment interaction. Acceptability was inversely related to treatment restrictiveness and, except for differential reinforcement of other behaviors (DRO), all treatments were more acceptable for the severe problem than for the mild problem.     

Perceived Barriers to Treatment Participation and Treatment Acceptability Among Antisocial Children and Their Families

This study examined the role of perceived barriers to participation in treatment and the acceptability of treatment among children and parents. Children (N = 144, ages 6–14) referred for outpatient treatment for oppositional, aggressive, and antisocial behavior and their families participated. The main findings were that: (a) perceived barriers to participation in treatment predicted treatment acceptability as rated by children and parents; (b) the effect was not accounted for by socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction; and (c) treatment acceptability was related to therapeutic change in the children over the course of therapy but the relation was small. Overall, the findings indicate that families vary considerably in the barriers they perceive in coming to treatment and that these barriers influence the extent to which they and their children evaluate the acceptability of the treatments they receive. The implications of treatment acceptability for evaluation and delivery of psychotherapy are discussed.     

Evaluating the influence of problem function on treatment acceptability

Direct care staff from community agencies serving individuals with developmental disabilities rated the acceptability of two treatments, time out and guided compliance, applied to a problem behavior maintained by attention or escape. The results showed that time out was significantly more acceptable than guided compliance regardless of problem function. The results indicate that the less restrictive treatment was rated as more acceptable. However, the functional treatment was not rated as more acceptable than the nonfunctional treatment. ©1997 John Wiley & Sons, Ltd.     

Treatment acceptability among mexican american parents

There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for differences in treatment acceptability. Mexican American parents found response cost, a punishment-based technique, more acceptable than positive reinforcement-based techniques (e.g., differential attention). Results suggest that Mexican American parents' acculturation has little impact on acceptability of child management interventions. No association was found between mothers' acculturation and treatment acceptability. However, more acculturated Mexican American fathers viewed token economy as more acceptable than less acculturated fathers. Results are discussed in the context of clinical work and research with Mexican Americans.     

Effectiveness and acceptability of parent training via telehealth among families around the world

Teaching parents to conduct functional analyses and to implement functional communication training is an efficacious approach for treating socially maintained problem behavior (Derby et al., 1997). Research has found that delivering this assessment and intervention package via telehealth technologies is efficient and acceptable to caregivers in the United States (Wacker et al., 2013b). We replicated this work with families residing in rural and urban areas of eight countries. Two behavior therapists located in the United States conducted appointments in the participants' native languages, using interpreters as needed. Parent‐implemented functional analyses and treatment with functional communication training were highly effective in reducing problem behavior in children diagnosed with autism. Furthermore, parents rated the procedures as acceptable and indicated that the treatment would be effective with their children. These findings indicate that telehealth technologies are a viable option for clinicians to provide behavior analysis services to families around the world.     

Acceptability of behavioral staff management techniques

This study describes an extension of Kazdin's work on acceptability of behavior therapy methods to the assessment of acceptability in the developing field of behavioral staff management. An instrument for assessing acceptability of behavioral staff management techniques was developed and then used to assess staff evaluations of four techniques that have been researched in the staff management literature (instruction, reinforcement, punishment, self-management). The effects on acceptability of problem difficulty and duration of supervisor-staff interaction were also investigated. Staff identified the techniques as having differing degrees of acceptability, with instruction rated most acceptable, followed in order by self-management, reinforcement, and punishment. Ancillary studies supported the reliability and validity of the scale. Results are placed within the context of a recent behavioral supervision model, and discussed in terms of social validity and consumer satisfaction issues. Implications for delivering behavioral staff management interventions are presented.     

Achieving socially significant reductions in problem behavior following the interview‐informed synthesized contingency analysis: A summary of 25 outpatient applications

Jessel, Hanley, and Ghaemmaghami (2016) reported the results of 30 interview‐informed, synthesized contingency analyses (IISCAs) and found the IISCAs to be an effective tool for identifying the functions of problem behavior across a variety of topographies, participants, and settings. Jessel et al. did not, however, include data on the effectiveness of the corresponding treatments. In the current study, we collected and summarized 25 additional applications, from analysis to treatment, in which the IISCA was applied in an outpatient clinic. The IISCA identified various social functions of problem behavior, which informed personalized treatments of functional communication training with contingency‐based reinforcement thinning. A 90% or greater reduction in problem behavior was obtained for every participant by the end of the treatment evaluation. The assessment and treatment process was socially validated by caregivers who rated the procedures highly acceptable and helpful, and the improvement in their child's behavior highly satisfactory.     

Treatment Acceptability

The present study assessed mothers' and fathers' acceptance of six interventions frequently used to alter children's problem behavior. This is the first study to assess fathers' perceptions of behavioral interventions for children. Positive reinforcement, response cost, medication, room timeout, chair timeout and spanking were rated by parents using the Treatment Evaluation Inventory (TEI). In addition, parents' perceptions of their children's behavior and own marital adjustment were measured using standardized checklists. Parents' acceptability ratings differed significantly across treatment conditions depending on parent gender, child behavior problems, and marital adjustment. Treatment preference order was equivalent for all groups.     

The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50% of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents' ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered.     

The home point system: token reinforcement procedures for application by parents of children with behavior problems

Parent-child problems within the home are frequently reported to be instances in which children refuse to help with household chores, bicker among themselves, or engage in verbally inappropriate behavior toward their parents. The present study investigated the effects of a token reinforcement program administered by the parents in ameliorating these problems. Two sets of parents, with a total of five children between the ages of 5 and 10 yr, were taught to administer a token economy within their homes. The parents received instruction in specifying desired social and chore behaviors, communicated these behavioral goals to their children, recorded data on their occurrence, and managed a point system backed with reinforcers normally found in the home. The token reinforcement program was shown to have successfully modified 15 problem behaviors in Family 1 and six in Family 2. In addition, the parents rated all 21 behavior changes as significant improvements. These studies indicated that some cooperative parents need only a small amount of professional help to learn to manage their children's behavior problems with token reinforcement procedures.     

The Relationship Between Treatment Acceptability and Youth Outcome in Group CBT for Youth with ASD and Anxiety

Anxiety is one of the most common co-occurring diagnoses in youth with autism spectrum disorder (ASD). Cognitive behavior therapy (CBT) is an evidence-based treatment that has been tailored for youth with ASD and anxiety and has shown good efficacy in reducing youth anxiety immediately after treatment. One area that has not been widely studied is acceptability of CBT for anxiety in this population. Acceptability includes beliefs about the potential helpfulness and satisfaction with a given treatment and may be important in understanding treatment outcomes. This study focuses on parent, youth, and clinician acceptability of a well-researched CBT program, Facing Your Fears, for youth with ASD and anxiety. Data was collected as part of a larger multi-site study that compared three different instructional conditions for clinicians learning the intervention. Results indicated that parents rated acceptability as higher for the overall treatment compared to youth. Further, youth and parents rated exposure related sessions as more acceptable than psychoeducation, and higher exposure acceptability ratings were predictive of lower youth anxiety levels post-treatment. Clinicians who received ongoing consultation rated treatment acceptability lower than clinicians in the other training conditions. While some clinicians may be hesitant to implement exposure techniques with this population, findings suggest that it is the technique that parents and youth rated as the most acceptable. Results are discussed in terms of treatment and research implications for youth with ASD and their families.