The problem: American education the solution: Use behavior analytic technology

In spite of numerous demonstrations that America's youth can be effectively educated with behavior analytic teaching techniques, few of the country's children are benefiting from the technology. In addition scholarly reviews of effective teaching strategies have often omitted reference to behavior analysis. One way to look at this problem is as a two-step operation. First, it is necessary to determine procedures that work; second it is necessary to devise strategies for effective dissemination. The present issue of JOBE (Vol. 1, No. 3, Sept. 1991) contains the recommendations of six outstanding behavioral educators as to how to deal with the dissemination problem. The initial article by Pumroy and McIntire describes the activities of an organization which trains school psychologists and teachers to use behavioral procedures and advocates for the techniques with a number of audiences. Next, Engelmann suggests that the public have more control over school activities and that legal action be taken against irresponsible administrative decisions. Hall advocates for less labor-intensive procedures and the sale of curricular materials based on behavioral principles. Binder proposes that dissemination of the technology become a private endeavor that responds to consumer needs. Rosenfield describes a collaborative model of consultation that increases treatment adherence. Finally, Albers and Greer describe research that isolates a key teacher behavior that results in greater academic proficiency.     

Computer-based intervention with coaching: an example using the Incredible Years program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.     

Computer‐Based Intervention with Coaching: An Example Using the Incredible Years Program

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence‐based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer‐ and web‐based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self‐determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence‐based interventions.     

认知行为疗法在儿童社会退缩行为干预中的新进展

社会退缩行为指儿童在社会情境中抑制自己参与同伴互动并表现出独处的行为。社会退缩阻碍儿童形成良好的社交能力,影响其人格和认知的健康发展,因而对儿童社会退缩行为进行及时干预显得十分重要。研究对认知行为疗法在儿童社会退缩行为干预中的进展进行了整合,包括虚拟现实暴露疗法、学校情境下的认知行为治疗及网络认知行为治疗。未来研究应设计针对社会退缩行为不同亚类型的干预方案,以及在干预中重视情绪调节的训练和教师的介入。     

EVALUATION OF A TRAINING MANUAL FOR THE ACQUISITION OF BEHAVIORAL ASSESSMENT INTERVIEWING SKILLS

Two procedures were used to teach behavioral assessment interviewing skills: a training manual and one-to-one instruction that included modeling, rehearsal, and feedback. Two graduate students and two advanced undergraduates were trained with each procedure. Interviewing skills were recorded in simulated assessment interviews conducted by each student across baseline and treatment conditions. Each training procedure was evaluated in a multiple baseline across students design. The results showed that both procedures were effective for training behavioral interviewing skills, with all students reaching a level of 90%-100% correct responding. Finally, a group of experts in behavior analysis rated each interviewing skill as relevant to the conduct of an assessment interview and a group of behavioral clinicians socially validated the outcomes of the two procedures.     

Improving adherence to fluid restrictions in male hemodialysis patients: a comparison of cognitive and behavioral approaches.

A cognitive intervention and a behavioral intervention were compared to determine their relative effectiveness in reducing interdialytic weight gain (IWG) among eight adult male hemodialysis patients. The behavioral model consisted of positive reinforcement, shaping, and self-monitoring. The cognitive model consisted of a counseling intervention designed to modify health beliefs. Three small-sample experimental studies showed that both interventions produced immediate reductions in IWG. However, the behavioral intervention was superior to the cognitive intervention in producing maintenance of reduced weight gain. Combining the interventions resulted in no improvement over the behavioral intervention alone. Continuation of self-monitoring procedures produced maintenance of improvements up to 2 months posttreatment. Repeated-measures analysis of variance showed changes for only the "barriers" dimension of the health belief model (Hartman & Becker, 1978) (p < .001), and this occurred only following or concurrent with adherence behavior change. Suggestions for treatment and future research are offered.     

BEHAVIORAL TRAINING FOR SIBLINGS OF AUTISTIC CHILDREN

The present study was conducted to investigate the effectiveness of a program designed to teach behavior modification procedures to normal siblings of autistic children. Three sibling pairs participated in a multiple-baseline analysis of the effects of training the normal siblings to use behavior modification procedures to teach their autistic brother or sister a variety of learning tasks. Results indicated that the siblings learned to use the behavioral procedures at a high level of proficiency, they used the procedures in a generalization setting, and there were observed improvements in the behavior of the autistic children. In addition, a social validation assessment of the normal siblings' statements about their autistic sibling indicated a decrease in negative statements and an increase in positive statements after training. These results are discussed in terms of the potential for incorporating siblings into the treatment plan in intervention programs with autistic children.     

The challenge of understanding process in clinical behavior analysis: the case of functional analytic psychotherapy

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change principles used to bring about therapeutic improvements in adult outpatients whose clinical problems stem from ineffective interpersonal repertoires. These principles include contingent responding to behavioral excesses and deficits by a therapist who has established him- or herself as a salient source of social reinforcement. Empirical support for FAP is emerging, but a variety of pragmatic and theoretical questions warrant investigation. Among the issues described in this paper are the training and dissemination of procedures for how to conduct a functional analysis, how to train therapists to identify functional stimulus classes, how to best address decreasing problem behavior without creating an aversive environment, how to enhance generalization, and how to account for the principle of equifinality when trying to specify therapeutic procedures. These and other issues stem largely from trying to disseminate a behavioral principle-based intervention rather than a topographically specified intervention. These issues present challenges and research opportunities for applied clinical behavior analysts if they wish to extend their science to address clinical issues important to the treatment of adult outpatients with normal intellectual functioning.     

Stimulus Fading and Response Elaboration in Differential Reinforcement for Alternative Behavior

A hallmark of applied behavior analysis is the development of function‐based interventions for problem behavior. A widely recommended function‐based intervention is differential reinforcement of alternative behavior (DRA), in which reinforcement is contingent upon socially acceptable alternatives to problem behavior (e.g., teaching communication skills). Typically, DRA is introduced under rich schedules of reinforcement. Although effective for initiating behavior change, rich schedules are often impractical in the natural setting. In this study, we evaluated the extent to which a stimulus fading program could be employed to elaborate alternative behavior (mands) in two individuals diagnosed with an autism spectrum disorder. For both participants, problem behavior was reduced substantially upon implementation of the DRA procedure. Further, problem behavior rates remained low and mand rates decreased to more practical levels as the DRA behavioral requirements increased during the fading program. The fading approach demonstrated in this paper may be a useful component of intervention packages for clinicians. Copyright © 2015 John Wiley & Sons, Ltd.     

Data Smoothing: Prediction of Human Behavior, Detection of Behavioral Patterns, and Monitoring Treatment Effectiveness in Single-Subject Behavioral Studies

Data-smoothing can be particularly useful in predicting human behavior, detecting behavioral patterns, and monitoring treatment effectiveness in highly variable single-subject behavioral experiments that cannot be determined by only visual inspection of their graphs. Using an example from the applied behavior analytic literature, the use of moving-average and exponential data-smoothing aided the detection of the unique behavioral patterns of a child with autism across different treatments. Furthermore, the utility of the data-smoothing procedures to monitor and control the effectiveness of an intervention is discussed. The ease of their calculations suggest use of data-smoothing by behavior analysts whenever the effects of particular interventions are questionable.     

BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

Promoting healthy food consumption among young children: Evaluation of a multi-component nutrition education program

This study was an outcome evaluation of a multi-component nutrition education program for African American kindergarten and first grade students attending an under-resourced urban school. The program focused on increasing fruit and vegetable knowledge and vegetable consumption during school lunch. It included a classroom-based knowledge change component, a lunchtime-based behavior-change component, and a home component. This program was unique in that natural helpers in the school (i.e., paraprofessionals) were enlisted as agents of behavior change. Findings indicated that the program was considered socially valid from the perspectives of students, teachers, and paraprofessional community assistants. Implementation integrity was acceptable for the classroom intervention, but highly variable for the lunchtime intervention. Program outcomes demonstrated that knowledge change was high, but behavior change was variable. Inconsistent behavioral effects appeared to be related in part to the variable level of intervention integrity. The challenges of promoting intervention integrity with paraprofessionals were discussed, and strategies for improving integrity were outlined.     

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.     

WHY NO GUIDELINES FOR BEHAVIOR MODIFICATION?

This paper reviews the guidelines for behavioral programs published by the National Association of Retarded Children. The review discusses a number of reasons why guidelines should not be enunciated for behavior modification, e.g., the procedures of behavior modification appear to be no more or less subject to abuse and no more or less in need of ethical regulation than intervention procedures derived from any other set of principles and called by other terms. The review recommends alternative methods for protecting the rights of clients who participate in behavioral programs. Specifically, behavioral clinicians, like other therapists, should be governed by the ethics codes of their professions; also, the ethics of all intervention programs should be evaluated in terms of a number of critical issues.     

SOME ETHICAL CONSIDERATIONS OF SHORT-TERM WORKSHOPS IN THE PRINCIPLES AND METHODS OF BEHAVIOR MODIFICATION1

Workshops and seminars to expose different sectors of the professional community to the principles and applications of behavior modification are briefly discussed. The possible misapplication of procedures by conference participants, whose only exposure to behavioral methods has been at these workshops is viewed as a potentially serious ethical issue. It is suggested that the goals of such seminars and workshops must be clarified, and methods of evaluation of the participants' skills devised, lest we contribute to the misapplication of procedures and to the criticism that behavioral methods are unethical approaches to treatment.     

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.     

Application of an Integrated Behavioral Model to Predict Condom Use: A Prospective Study Among High HIV Risk Groups1

An integrated theoretical model using constructs from multiple behavioral models was applied to understand and predict condom use among a sample of injecting drug users, commercial sex workers, men who have sex with men, and multipartnered heterosexuals. Elicitation interviews were conducted to develop a questionnaire to measure model constructs that may be predictive of condom use for sex with vaginal, anal, and oral regular and casual partners. A prospective survey design was used, with 993 participants interviewed at Time 1, and 686 returning for Time 2 interviews 3 months later. Regression analyses were conducted using Time 1 measures to predict intention and Time 2 behavior. Strong support was found for a model that includes attitude, social norm, and facilitators/constraints as predictors of behavior, with multiple correlations in the 0.20 to 0.40 range. Findings also indicate perceived control and facilitators/constraints are distinct constructs and both, along with attitude and social norm, contribute to explaining behavioral intention. Implications for intervention development are discussed.     

How to behave ethically in a world of fads

Although applied behavior analysis (ABA) has significant scientific support for treating people with autism spectrum disorders (ASDs), the field of autism treatment has been plagued with rapidly proliferating fad treatments subjecting people with ASD to various ineffective, pseudoscientific, and antiscientific treatments. To combat this, professionals must learn to make ethical treatment decisions, sometimes before research is conducted or published. Even when research is available negating fads, behavioral professionals must also overcome misperceptions about ABA. The purposes of this paper are to provide behavioral professionals with (a) a mechanism for making ethical treatment decisions (using sensory integration as an example) and (b) a method for responding to potential misperceptions and obstacles to using ABA. Copyright © 2010 John Wiley & Sons, Ltd.     

A school-based intervention to reduce aggressive behavior in maladjusted adolescents

A structured group intervention, using bibliotherapy and clarifying processes, was designed to reduce (a) aggressive behavior, (b) endorsement of beliefs that support aggression, and (c) generally maladjusted behavior. Based on the belief that learning is not only a rational process, but incorporates a strong emotionally driven experiential system, this treatment program sets out to deal with emotions associated with aggression. It is psychodynamically oriented, and, like most school treatments implements cognitive and behavioral elements. For 2 years, 117 socially maladjusted male adolescents in three special education schools in Israel participated in the program. Results for the 2 years are inconsistent: the 2nd-year study was more effective than the 1st-year study in reducing aggression as well as other maladjusted social behavior; withdrawal was the only variable affected consistently, and the program did not reduce attitudes that support aggression. The control group, however, showed increased endorsement of beliefs that support aggression and increased aggression and acting-out behavior. These results support the intervention in two ways: (a) They suggest some control over the increase in maladjusted behavior with time, and (b) they indicate a reduction in aggressive behavior for most students. The salient result concerning change in withdrawal behavior is discussed in light of the psychodynamic principles and methods associated with the intervention.