CHOICE MAKING TO PROMOTE ADAPTIVE BEHAVIOR FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL CHALLENGES

Two analyses investigated the effects of choice making on the responding of elementary school students with emotional and behavioral challenges. In the first analysis, 2 participants were given choices from menus of academic tasks, all of which were pertinent to their educational objectives in English and spelling, respectively. Reversal designs showed that the choice-making conditions increased task engagement and reduced disruptive behavior for both students. An additional analysis was performed with a 3rd student in an effort to further distinguish the effects of choice making from preference. In this study, one of the no-choice phases was yoked to a previous choice-making condition. This analysis demonstrated that the choice-making condition was superior to baseline and yoked control phases as determined by levels of task engagement and disruptive behavior. The findings of the two analyses contribute information relevant to students with emotional and behavioral disorders, and to a growing literature on the desirable effects of choice making for students with disabilities and challenging behaviors.     

BEHAVIORAL AND STIMULANT TREATMENT OF HYPERACTIVE CHILDREN: A THERAPY STUDY WITH METHYLPHENIDATE PROBES IN A WITHIN-SUBJECT DESIGN

Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observations of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, highlighting the importance of behavioral parent training in the treatment of hyperactivity.     

Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder

We used a sequential approach to evaluate the relative and combined effects of different types of behavioral treatments, as well as dosage of methylphenidate (MPH), on the disruptive behavior of 3 students who had been diagnosed with attention deficit hyperactivity disorder. Results showed that individualized behavioral treatments produced decreases in disruptive behavior equivalent to MPH for all 3 participants and demonstrated the need to evaluate behavioral treatments and medication dosage on an individual basis.     

Relative Efficacy of Behavioral Interventions in Preschool Children Attending Head Start

This study tested the relative efficacy of two interventions for children referred for consultation services due to problem behavior in the classroom. Teachers nominated children for participation due to frequent disruptive behaviors, such as inappropriate vocalizations and off-task behavior. Four Black males from 3 to 4 years old who attended Head Start centers served as the participants. Each child received a functional assessment that included a teacher-completed functional assessment rating scale and a brief functional analysis. Following functional assessments, an alternating treatments design was used to test the relative efficacy of an intervention matched to function and the Mystery Motivator intervention, not matched to function. Results indicate that both the intervention matched to function and the Mystery Motivator intervention were superior to a no-intervention control condition, but the function-matched intervention was more effective than the Mystery Motivator intervention for reducing problem behaviors and increasing appropriate engagement for all four children. Results are discussed in terms of learning principles potentially responsible for differential efficacy, as well as implications for applied practice.     

Effects of Prevent-Teach-Reinforce on Academic Engagement and Disruptive Behavior

This study assessed the effectiveness of prevent-teach-reinforce (P-T-R), a functional behavioral assessment-based intervention for students with behavior problems, using an A-B-A-B design with follow-up. Participants included three students in kindergarten, fourth grade, and fifth grade in a rural Midwestern school district. P-T-R interventions were implemented with fidelity by all teachers and P-T-R was associated with mean decreases in disruptive behavior for all participants with Tau-U effect sizes ranging from minimal to strong. All three participants demonstrated mean increases in academic engagement with strong effect sizes. P-T-R interventions were associated with moderate to high levels of perceived social validity. Implications for consistent and efficient FBA-based interventions in schools are discussed.     

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.     

The Effect of Values Affirmation on Psychological Stress

There is growing evidence for the efficacy of acceptance-based behavioral therapies, which aim to increase acceptance of internal experiences and values-consistent action. Further, experimental studies have demonstrated that acceptance decreases distress and increases willingness to engage in challenging tasks (e.g. Levitt, Brown, Orsillo, & Barlow, 2004). However, research demonstrating the positive effects of values articulation on psychological functioning is needed. The goal of the present study was to evaluate the efficacy of a brief intervention in reducing anxiety related to a stressful speech task. Contrary to predictions, engagement in values writing did not reduce anticipatory or posttask anxiety relative to engagement in a neutral writing task. However, self-esteem significantly predicted anxious response to the task. Experiential avoidance and valued living were also associated with anxious response to the task, although the contribution of these predictors was not statistically significant.     

From “4Rs and 2Ss” to “Amaka Amasanyufu” (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context

In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children’s drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

Assessing pharmacological and contingency management interventions with mentally retarded adolescents in a residential treatment program

Two studies were performed using applied behavior analytic methodology to evaluate pharmacological and contingency management interventions with mentally retarded adolescents in a residential treatment facility. In the first study, stimulant (methylphenidate) and beta-blocking (propranolol) medications were compared with an overcorrection procedure to manage the disruptive vocalizing of a 14-year-old female. In the second study. the effects of thioridazine and a reinforcement-response interruption program on stereotypic body-rocking of an 18-year-old male were assessed. Both studies failed to demonstrate a positive response from any of the prescribed medications. Substantial reductions in behavior did occur with application of the contingency management programs. The programs were equally effective whether utilized alone or in combination with medication. Assessment and programmatic issues in the area of clinical behavioral pharmacology are discussed.     

Using Class Pass Intervention to Decrease Disruptive Behavior in Young Children

Previous research has shown that disruptive behavior can impair students’ academic success (Pierce et al. in Remedial Spec Educ 25:175–188, 2004, https://doi.org/10.1177/07419325040250030501), as well as increase teacher’s stress level (Westling in Remedial Spec Educ 31:48–63, 2010, https://doi.org/10.1177/0741932508327466). The Class Pass Intervention (CPI) is a Tier 2 intervention designed to decrease disruptive behavior and increase academic engagement; however, few studies have evaluated the efficacy of CPI. The purpose of this study was to assess the effects of CPI on disruptive behavior and academic engagement of young students who engage in disruptive behavior. This study used a non-concurrent multiple baseline design to assess experimental control. In the current study, CPI led to a decrease in disruptive behavior and an increase in academic engagement for all three participants and these levels persisted throughout schedule thinning. In addition, results of teacher and student social validity assessments indicated that the intervention was effective and easy to implement and that students preferred the intervention.

     

Behavior Therapy and Callous-Unemotional Traits: Effects of a Pilot Study Examining Modified Behavioral Contingencies on Child Behavior

The conduct problems of children with callous-unemotional (CU) traits (i.e., lack of empathy, lack of guilt/lack of caring behaviors) are particularly resistant to current behavioral interventions, and it is possible that differential sensitivities to punishment and reward may underlie this resistance. Children with conduct problems and CU (CPCU) are less responsive to behavioral punishment techniques (e.g., time-out), whereas reward techniques (e.g., earning points for prizes or activities) are effective for reducing conduct problems. This study examined the efficacy of modified behavioral interventions, which de-emphasized punishment (Condition B) and emphasized reward techniques (Condition C), compared with a standard behavioral intervention (Condition A). Interventions were delivered through a summer treatment program over 7 weeks with an A-B-A-C-A-BC-A design to a group of 11 children (7–11 years; 91% male). All children were diagnosed with either oppositional defiant disorder or conduct disorder, in addition to attention-deficit hyperactivity disorder. Results revealed the best treatment response occurred during the low-punishment condition, with rates of negative behavior (e.g., aggression, teasing, stealing) increasing over the 7 weeks. However, there was substantial individual variability in treatment response, and several children demonstrated improvement during the modified intervention conditions. Future research is necessary to disentangle treatment effects from order effects, and implications of group treatment of CPCU children (i.e., deviancy training) are discussed.     

Behavioral Momentum During a Continuous Reading Task: An Exploratory Study

Adolescents with emotional and behavioral disorders (EBD) often fail to master literacy skills, in part because disruptive behaviors interfere with task engagement and persistence. The theory of behavioral momentum explains the persistence of behavior in the face of changing environmental conditions. The current exploratory study examined variables related to behavioral momentum in the context of a continuous reading task. Participants were three adolescents identified with EBD who were instructional on fifth-grade material. Results indicated that when participants read a third-grade paragraph immediately before a fifth-grade paragraph, they decreased the latency to initiate reading of the fifth-grade paragraph and increased words read correctly per minute on the first 10 words of the fifth-grade paragraph. Results are discussed in terms of the theory of behavioral momentum and the nature of interventions that may be developed to increase reading persistence.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

Further analysis of the separate and interactive effects of methylphenidate and common classroom contingencies

We evaluated separate and interactive effects between common classroom contingencies and methylphenidate (MPH) on disruptive and off-task behaviors for 4 children with a diagnosis of attention deficit hyperactivity disorder. Analogue conditions consisting of contingent teacher reprimands, brief time-out, no interaction, and alone were conducted in a multielement design. Medication status (MPH or placebo) was alternated across days in a superordinate multielement design. Results indicate that (a) the behavioral effects of MPH were influenced by one or more of the analogue conditions for each participant, and (b) time-out was associated with zero or near-zero levels of both disruptive and off-task behavior for 3 of the 4 participants during MPH and placebo conditions. Implications for the clinical effectiveness of MPH and possible behavioral mechanisms of action of MPH in applied settings are discussed.     

STIMULUS CHARACTERISTICS WITHIN DIRECTIVES: EFFECTS ON ACCURACY OF TASK COMPLETION

Three experiments were conducted in an outpatient setting with young children who had been referred for treatment of noncompliant behavior and who had coexisting receptive language or receptive vocabulary difficulties. Experiment 1 studied differential responding of the participants to a brief hierarchical directive analysis (least‐to‐most complex stimulus prompts) to identify directives that functioned as discriminative stimuli for accurate responding. Experiment 1 identified distinct patterns of accurate responding relative to manipulation of directive stimulus characteristics. Experiment 2 demonstrated that directives identified as effective or ineffective in obtaining stimulus control of accurate responding during Experiment 1 continued to control accurate responding across play activities and academic tasks. Experiment 3 probed effects of the interaction between the type of directive (effective vs. ineffective) and the reinforcement contingency (differential reinforcement for attempts vs. differential reinforcement for accurate responses) on accurate task completion and disruptive behavior. Results suggested that behavioral escalation from inaccurate responding to disruptive behavior occurred only when ineffective directives were combined with differential reinforcement for accurate task completion. The overall results are discussed in terms of developing a methodology for identifying stimulus characteristics of directives that affect accurate responding.     

Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

PROGRAMMING PARTICIPATION IN FAMILY ACTIVITIES FOR CHILDREN WITH AUTISM: PARENTS' USE OF PHOTOGRAPHIC ACTIVITY SCHEDULES

The parents of 3 boys with autism were taught to help their children follow photographic activity schedules depicting a variety of home-living tasks. A multiple baseline across participants showed that the home-based intervention produced increases in children's engagement and social initiations and decreases in disruptive behavior, which were maintained for as long as 10 months.     

PARENT EDUCATION INTERVENTION RESULTS IN DECREASED CHALLENGING BEHAVIOR AND IMPROVED TASK ENGAGEMENT FOR STUDENTS WITH DISABILITIES DURING ACADEMIC TASKS

Children with developmental disabilities and attention deficit hyperactivity disorder often engage in challenging behavior when presented with academic demands. Parents of school‐age children with such diagnoses are commonly asked to assist their child with academic tasks but may struggle to do so as a result of challenging behavior. This study evaluated the effects of a parent education intervention on the challenging behaviors and task engagement of three school‐age children with disabilities during academic activities. Parent education consisted of (i) weekly didactic instruction; (ii) modeling; (iii) role‐play; and (iv) in vivo coaching and performance feedback. Using a non‐concurrent multiple baseline across participants with embedded individual multi‐element design, this study demonstrates that a parent education intervention results in decreases in challenging behavior and increases in task engagement. These results suggest that parent education focused on addressing challenging behavior during one‐to‐one instruction may facilitate completion of academic tasks. Implications for practice and suggestions for future research are discussed. Copyright © 2013 John Wiley & Sons, Ltd.