The efficacy of noncontingent escape for decreasing children's disruptive behavior during restorative dental treatment

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff s use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.     

DENTIST-IMPLEMENTED CONTINGENT ESCAPE FOR MANAGEMENT OF DISRUPTIVE CHILD BEHAVIOR

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

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.     

Home-based reinforcement: Behavioral covariation between academic performance and inappropriate behavior

This article describes the effects of a home-based reinforcement program on the academic performance and inappropriate behaviors of 3 fourth-grade boys. Home contingencies were placed on only academic performance. The home-based system resulted in marked increases in academic performance and large decreases in disruptive behavior for all three subjects. Throughout baseline and treatment conditions, there was a strong negative correlation between academic performance and disruptive behavior. The intervention was evaluated using both visual inspection (multiple baseline across subjects) and interrupted time-series analysis.     

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.     

Student-Administered Group-Oriented Contingencies:

This study introduced the student-administered group-oriented contingency intervention as a means of increasing arithmetic performance of grade-school children. Arithmetic performance and disruptive behavior were measured across a clinic and natural school setting for four underachieving fifth grade boys. The effectiveness of this intervention was assessed with an ABAB withdrawal design. Concurrent with treatment phases in the clinic setting, generalization to the school setting was evaluated. Findings indicated all four participants showed increases in arithmetic performance in the clinic during treatment phases paralleled by decreases in nontreated disruptive behavior. The first treatment phase in the clinic yielded no spontaneous setting or behavior-setting generalization. Stimuli common to the clinic setting were programmed into the school setting concurrent with the second treatment phase. This procedure resulted in setting and behavior-setting generalization. Further implications of this treatment strategy were discussed.     

Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access.

This study evaluated a distraction intervention designed to reduce the distress of preschool children undergoing repeated chemotherapy injections. Twenty-nine children aged 2-5 years were randomly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control. Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition. The improvements were maintained over the 8-week intervention. The results suggest that a developmentally appropriate, multisensory, variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children.     

A Comparison of Function-Based Differential Reinforcement Interventions for Children Engaging in Disruptive Classroom Behavior

This study provides a direct comparison of differential reinforcement of other behavior (DRO) and differential reinforcement of alternative behavior (DRA). Participants included three children in center-based classrooms referred for functional assessments due to disruptive classroom behavior. Functional assessments included interviews and brief functional analyses. An alternating treatments design was used to evaluate the relative effectiveness of function-based DRO and DRA interventions. Results indicated that both intervention procedures effectively reduced disruptive behavior, but the DRA procedure consistently resulted in greater reductions in disruptive behavior across all participants. Results are discussed in terms of directions for future functional assessment and intervention research as well as implications for applied practice.     

An initial investigation of baseline respiratory sinus arrhythmia as a moderator of treatment outcome for young children born premature with externalizing behavior problems

The aim of the current study was to examine the moderating effect of baseline respiratory sinus arrhythmia (RSA) on Parent-Child Interaction Therapy (PCIT), a behavioral parent-training intervention, for young children born premature. In this pilot randomized controlled trial, 28 young children (mean age of 37.79 months), who were born <37 weeks gestation and presented with elevated externalizing behavior problems, were randomly assigned to an immediate treatment or waitlist control group. RSA, which provides an approximate marker of individual differences in cardiac vagal tone, was measured during a baseline period. Past research has generally shown that higher levels of baseline RSA correlate with various positive psychological states (e.g., empathy, sustained attention), whereas lower levels of baseline RSA correlate with less optimal psychological states (e.g., higher externalizing behavior problems). Results indicated that baseline RSA significantly interacted with treatment condition in predicting changes in child disruptive behavior. Specifically, low levels of baseline RSA were associated with greater improvements in child disruptive behavior following PCIT. While acknowledging the caveats of measuring and interpreting RSA and the need to include a sympathetic-linked cardiac measure in future research, these findings provide preliminary evidence that children with lower capacity for emotion regulation receive even greater treatment gains. Future research should also examine the moderating effect of RSA in larger samples and explore the potential mediating role of RSA on behavioral parenting interventions.     

Effects of High-Probability Request Sequences on Preschoolers' Compliance and Disruptive Behavior

A high-probability request sequence was implemented with three preschool children with developmental delays within their classroom during typical activities. A multiple baseline design across subjects was used to evaluate the effects of the high-probability request sequence on compliant responding to low-probability requests and the occurrence of disruptive behavior. Results of the study indicate that the use of the high-probability request sequence was effective in increasing compliant responding to low-probability requests delivered by two different trainers for all children. No increases in disruptive behavior were noted as a result of using the high-probability request sequence. When the high-probability request sequence was withdrawn, compliant responding to low-probability requests was maintained for all children across time and in different settings.     

Open-Trial Pilot of Parent-Child Interaction Therapy for Children With Autism Spectrum Disorder

In this pilot study, the effectiveness and feasibility of Parent-Child Interaction Therapy (PCIT) for decreasing disruptive behavior was evaluated in 17 young children with Autism Spectrum Disorder (ASD). PCIT is a behaviorally based play therapy which targets the parent-child relationship through live coaching of play interactions and the implementation of consistent discipline techniques. Following an average of 19 sessions, disruptive behavior as measured by multiple indices significantly decreased. Congruently, parents increased positive parental following skills and decreased negative parental leading skills across the course of treatment. In addition, parents reported increased levels of child functional communication and prosocial behavior. High levels of parent acceptability of the intervention were also noted. Effect sizes were medium to large across measured dependent variables, including parent report and behavioral observations. Implications for the clinical use of PCIT within an ASD population and future research with controlled outcome studies are discussed.     

Treatment Effectiveness of a Brief Behavioral Intervention for Preschool Disruptive Behavior

Parent management training is an evidence-based treatment for disruptive behavior. However, the number of treatment sessions can be high, contributing to high attrition rates. The purpose of this study was to examine post-treatment, 6-month, and 1-year treatment outcomes of the Brief Behavioral Intervention. One hundred twenty children aged 2–6.5 years demonstrating clinically significant disruptive behavior were referred to an outpatient clinic for treatment and participated in the study. Attrition was below reported rates in the literature. Significant decreases in child disruptive behavior and parent stress were found from pre-to-post intervention, and improvements were maintained at follow-ups. Significant pre-to-post intervention teacher reported decreases in behavior were reported.     

Parceling Component Effects of a Multifaceted Prevention Program for Disruptive Elementary School Children

This study examined predictors and outcomes of attendance in two standard components of a multifaceted preventive intervention aimed at children with early-onset disruptive behavior after 3 years of intervention. Mean rate of attendance in the Family Program, but not the Summer School Program, differed by level of child disruptiveness (grouping variable). Although predictors of attendance (SES, single-parent status, child IQ) did not differ across high- and low-disruptive groups, predictors of outcome were moderated by level of child disruptiveness for academic achievement and aggression outcomes, but not for social competence. Higher attendance in the Summer Program was associated with higher child social competence at Year 3 for all children. For academic achievement, higher attendance in the Summer Program was associated with higher scores for mild/moderately disruptive children and lower scores for highly disruptive children in Year 3. Higher attendance in the Family Program was associated with lower aggression scores for mild/moderately disruptive children. Findings highlight the importance of matching intervention components to the assessed or expressed needs of client subgroups.     

Multimethod Psychoeducational Intervention for Preschool Children with Disruptive Behavior: Two-Year Post-Treatment Follow-up

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.     

Self-regulation in the modification of disruptive classroom behavior

This study compared self-regulation and external regulation procedures in the treatment of children's disruptive classroom behavior. After baseline data were collected, three of the four most disruptive children in each of 10 first- and second-grade classrooms received reinforcement for achieving low rates of disruptive behavior. The fourth child served as a control subject throughout the experiment. Two of the three experimental subjects were then taught to self-observe their own disruptive behavior. In the final reinforcement period, these subjects were given control over dispensing reinforcers to themselves, based on their self-collected behavioral data while subjects in the other experimental group continued with the externally managed reinforcement. In extinction, reinforcement was discontinued for all subjects, but one of the self-regulation subjects in each classroom continued overtly to self-observe. Results indicated that both reinforcement programs reduced disruptive behavior. The self-regulation procedures were slightly more effective in reducing disruptiveness than was the external regulation procedure, and this advantage persisted into extinction. These results suggest that self-regulation procedures provide a practical, inexpensive, and powerful alternative in dealing with disruptive behavior in children.     

Decreasing Child Distress During Needle Sticks and Maintaining Treatment Gains Over Time

This study examined the effectiveness of an intervention for reducing behavioral distress in children during needle sticks. Participants were eight children and their parents. The children received injections or venipunctures for hematological or oncological disease. The distress management intervention included instruction for children to engage in a distraction activity during needle sticks and parent training in coaching their children. The intervention was adapted to clinic and home treatment settings. Results indicated that five children exhibited significantly less distress after treatment when compared with baseline sessions, that treatment gains were maintained at follow-up for three of them, and that child distress was significantly and negatively related to use of the experimental distractor. Implications for clinical practice are discussed.     

Reinforcement therapy in the classroom

Teachers were trained in the systematic use of attention and praise to reduce the disruptive classroom behavior of four first-grade children. Observation measures showed a significant improvement from baseline to treatment for these children and no significant changes for same-class controls. While the amount of teacher attention to target children remained the same from baseline to treatment, the proportion of attention to task-relevant behavior of these children increased. Psychological tests revealed no adverse changes after treatment.