The effects of a response cost treatment tactic on hyperactive children

In a pilot study, a multielement design was used to assess the effectiveness of a response cost procedure on a 7-year-old child's hyperactive behavior and academic performance across days. The procedure was effective in reducing off-task behavior and in increasing academic assignment completion. In Experiment 2, three strategies were compared to a no-treatment baseline in treating an 8-year-old hyperactive child: drug (Ritalin) alone, response cost alone, and drug plus response cost. The cost program alone and the cost program combined with medication were effective in reducing off-task behavior and in increasing academic performance. In both studies, the procedure was viewed by the teachers as practical and effective for use in a classroom setting. The subjects liked the cost system and believed that they completed more academic work when it was operative.     

An investigation of various performance-based treatments with acrophobics

Five different performance-based treatments (participant modeling, participant modeling without therapist physical contact, modeling plus exposure, therapist-controlled exposure in vivo and rationale only) were compared to evaluate their relative effectiveness in the treatment of acrophobia. Ten subjects were assigned to each of the five groups. Avoidance behavior was assessed using a behavior test, self-report fear measures, heart-rate and self-efficacy expectation measures. Subjects were first submitted to two behavioral approach tests. These two pre-tests were administered 1 week apart, and no significant differences occurred between the evaluations. Analyses of variance for repeated measures at pre-test. post-test and follow-up revealed a significant improvement on all main outcome measures for the five groups. No significant differences among groups were observed. The total treatment time, which was also used as a dependent measure, did not yield any significant differences among treatment conditions. These findings have many implications. For instance, the need for induction aids, such as physical contact with the therapist and modeling, is questioned. Also, exposure per se whether therapist or self-controlled is shown to be effective in reducing avoidance behavior. Finally, the theoretical and clinical implications of these results are discussed.     

Flooding therapy: Effectiveness,stimulus characteristics,and the value of brief in vivo exposure

Three analogue experiments examined flooding therapy. Experiment 1 showed that flooding was more effective than standardized desensitization in reducing snake phobia. Experiment 2 examined three different modes of presenting the feared stimuli in flooding: taped auditory presentation, pictorial presentation, and a combination of these two. An additional combination group were given a brief in vivo exposure to the feared object immediately after each of three treatment sessions. Both a behavioral test and subjective estimates of fear showed advantages for the combined group that had the in vivo exposure, although it appeared that auditory instructions to imagine interaction with the snake was the best method for presenting the feared stimuli. Experiment 3 compared the auditory imagined method with and without ‘aversive’ or ‘implosive’ scenes, and with either an immediate or a delayed in vivo exposure. The only procedure to produce marked effects was the one that omitted ‘aversive’ scenes and provided immediate post-treatment in vivo exposure.     

Reinforced practice and reduction of different kinds of fears in adults and children

The purpose of this study was to determine whether or not fears with different origins, course and chronicity could be reduced by a common treatment program. A number of therapeutic procedures that had been experimentally demonstrated to be individually important in prior behavior modification studies with neurotic disorders were combined into a single therapeutic program called ‘reinforced practice.’ The combined elements were: graduated and repeated practice in approaching actual phobic stimuli: reinforcement for gains in performance; feedback of measurable progress; and instructions designed to arouse expectations of gradual success. In each of four experiments involving four different fears, namely fear of heights, snakes and electric shock in adults, and fear of darkness in young children, Ss who expeienced the ‘reinforced practice’ procedure improved their performance by a significant and substantial margin as compared to untreated control Ss. These results suggest that regardless of different etiologies, regardless of whether or not the fears are ‘rational’ or ‘irrational,’ and regardless of whether or not the fears are transitory or long lasting, the same treatment procedure can be equally effective in reducing escape-avoidance behavior.     

Treating Parents with Attention-Deficit/Hyperactivity Disorder: The Effects of Behavioral Parent Training and Acute Stimulant Medication Treatment on Parent–Child Interactions

This multiple baseline study evaluated the efficacy of behavioral parent training (BPT) for 12 parents (M age?=?39.17 years; 91 % mothers) and their children (ages 6–12; 83 % boys) both with Attention-Deficit/Hyperactivity Disorder (ADHD), and also explored the acute effect of stimulant medication for parents before and after BPT. Parents rated their own and their children’s symptoms and impairment and were stabilized on optimally dosed medication. Then, parents discontinued medication and were randomly assigned to a 3, 4, or 5 week baseline (BL), during which they provided twice-weekly ratings of their impairment, parenting, and their child’s behavior. Following BL, parents and their children completed two laboratory tasks, once on their optimally dosed medication and once on a placebo to assess observable effects of medication on parent–child behavior, and they completed additional assessments of family functioning. Parents then completed eight BPT sessions, during which they were unmedicated. Twice-weekly ratings of parent and child behavior were collected during BPT and additional ratings were collected upon completing BPT. Two more parent–child tasks with and without parent medication were conducted upon BPT completion to assess the observable effects of BPT and BPT plus medication. Ten (83.33 %) parents completed the trial. Improvements in parent and child behavior were observed, and parents reported improved child behavior with BPT. Few benefits of BPT emerged through parent reports of parent functioning, with the exception of inconsistent discipline, and no medication or interaction effects emerged. These results, although preliminary, suggest that some parents with ADHD benefit from BPT. While pharmacological treatment is the most common intervention for adults with ADHD, further examination of psychosocial treatments for adults is needed.     

“Generalized imitation” on a nonimitative task: Effects of modeling and task history

Two experiments investigated characteristic generalized imitation procedures on a nonimitative successive visual discrimination task. In Experiment I, no discriminative behavior was obtained though a number of procedures designed to enhance discrimination were employed. The introduction of a differential modeling procedure after nine or 10 sessions of nondifferential performance was ineffective in producing differential responding for three of four Ss. In the second experiment, the differential modeling procedure was introduced as an initial manipulation and was successful in establishing discriminative performance in all Ss. After several sessions of differential responding, the observation of a model performing nondifferentially was relatively ineffective in altering the pattern of responding. These results suggest (1) that modeling may be functional in altering a S's behavior depending on what point in the procedures the manipulation is introduced and (2) that certain procedural variables may define a functional response class characterized by the failure to develop discriminative responding.     

Psychoactive drug effects in a hyperactive child: A case study analysis of behavior change and teacher attention

The effects of methylphenidate on the behavior and teacher interactions of a 9-year-old hyperactive female were analyzed. Observations of the subject's task-related and disruptive behaviors and of interactions between the subject and her classroom teacher were made when the subject received the active drug and an inert placebo. Teacher's ratings of the subject's classroom behavior and measures of her academic performance were also obtained. Results showed that when the subject was receiving methylphenidate she engaged in task-related activities a greater percent of the time, had a higher percent of teacher interactions that were instructional in quality, and received lower behavior ratings by the teacher than when she was receiving a placebo. The results suggest that the use of medication may enable the hyperactive child to profit both behaviorally and academically.     

Effects of question type and experimenter position on bilateral differences in electrodermal activity and conjugate lateral eye movements

28 dextral males participated in a within-subjects experiment which tasted for the effects of question type (verbal versus spatial) and experimenter-position (in front of or behind the subject) on direction of conjugate lateral eye movements (LEMs) and bilateral differences in skin conductance responses (SCRs). Question dependent asymmetries were observed for LEM direction but not for SCR magnitude. Experimenter-position had no significant effect. The results for LEM direction are consistent with the hypothesis linking eye movements to the left or right with activation of the cerebral hemisphere contralateral to the direction of gaze. The results for SCR magnitude, given certain assumptions, can be reconciled with a hemispheric model of contralateral excitatory control of that system.     

Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.     

An evaluation of stimulant medication on the reinforcing effects of play

Although a vast literature has indicated that stimulant medications are effective for reducing inappropriate behavior in children with attention deficit hyperactivity disorder (ADHD), the effects of stimulant medication on ancillary behaviors (e.g., play) have yet to be investigated with the same rigor. We used a reinforcer assessment procedure to evaluate the effects of medication on the play and social behavior of 5 preschool children who had been diagnosed with ADHD. Conditions included (a) social reinforcement (i.e., playing with friends), (b) alone play, and (c) quiet time (i.e., resting). Results indicated that 1 of the 5 participants selected fewer social reinforcers and more nonsocial reinforcers (alone play or quiet time) while on medication. The findings indicate that the reinforcer assessment procedure may be a viable way to evaluate medication effects on an ongoing basis and to inform treatment decisions.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Habituation during exposure treatment: Distraction vs attention-focusing

To investigate the effects of distraction and attention-focusing during in-vivo exposure to feared stimuli, the responses of 16 obsessive-compulsives with washing rituals were studied. A cross-over design was employed in which 6 of the subjects underwent exposure with attention focusing on the first day followed by exposure with distraction on the second day. The remaining subjects received the reverse order. Habituation of both heart rate and subjective anxiety was observed under both conditions, the rate of habituation tending to remain constant throughout the 90-min exposure. Greater between-session habituation and greater synchrony between the psychophysiological and the subjective measures of anxiety was observed when attention-focusing preceded distraction. Since habituation and synchrony have previously been found to be positively related to treatment outcome, the present results suggest that treatment by exposure to feared stimuli may be more effective if attention-focusing is promoted.     

Social skills training and systematic desensitization in reducing dating anxiety.

Cooper et al. (1969) have criticized the types of target behavior chosen for therapy analogue studies for being irrelevant to clinical practice. A potential target behavior which appears to be pervasive, complex and directly relevant to clinical practice is interpersonal anxiety. Of special concern to college students is the interpersonal anxiety elicited by members of the opposite sex. especially in dating situations (Martinson and Zerface, 1970).An individual may experience interpersonal anxiety because of a deficit in social skills (reactive anxiety) or because of prior conditioning (conditioned anxiety) or because of some combination of both reactive and conditioned components. While it is possible that a treatment program aimed at a reduction of either of these anxiety components may be instrumental in ameliorating the other component, it would appear that a comprehensive treatment program would attempt to teach social skills as well as reduce conditioned anxiety.Desensitization procedures have demonstrated success in alleviating conditioned anxiety for a wide variety of clinical problems (Paul, 1969a. 1969b) and appears to be a logical choice for the conditioned component of dating anxiety. A number of outcome studies have reported some success in the use of in vivo desensitization (Rehm and Marston, 1968; Martinson and Zerface, 1970) and systematic desensitization (Stark, 1970) in reducing anxiety in date anxious subjects.The literature on treatment programs aimed at social skills training for date anxious subjects is meager. Melnick (1973) reported success in improving the appropriateness of the social behavior of subjects who had experienced a minimal dating history by the use of modeling, behavioral rehearsal and self-observation techniques.The present study was designed to test the relative effectiveness of two different types of treatment programs in alleviating interpersonal dating anxiety. The two experimental groups consisted of a systematic densensitization program which focused on the condition anxiety component and a social skills training program which focused on the reactive anxiety component.     

The effect of continuous, intermittent, and "placebo" reinforcement on the effectiveness of the conditioning treatment for enuresis nocturna

It has been suggested that intermittent reinforcement may be of value in reducing the rate of relapse in bedwetting conditioning therapy. An experiment was conducted with 30 enuretic boys to examine acquisition and extinction parameters of continuous (100%), intermittent (70% variable ratio), and “placebo” (0%) reinforcement schedules. Reinforced trials were administered as in the typical Mowrer conditioning procedure. Non-reinforced trials were achieved by means of a time delay with the subsequent alarm being activated in the parent's room rather than in the child's room. These procedures required the development of a new conditioning device which could be programmed to automatically administer the desired schedule of reinforcement. The results of the field investigation revealed that continuous reinforcement (CR) and intermittent reinforcement (IR) groups attained acquisition in approximately the same number of trials and with essentially the same success rate. Relapse rate was significantly greater in the CR group than in the IR group. The placebo group showed no improvement over the 6 weeks of treatment. The results of this study may be interpreted as supporting the tenet that relapse can be viewed and treated as an extinction of the acquired response.     

Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia.

A treatment protocol, called experiential cognitive therapy (ExCT), was developed. It integrated traditional cognitive behavior therapy (CBT) with virtual reality exposure for the treatment of panic disorder with agoraphobia (PDA). The objective of this study was to test the efficacy of short-term (four sessions) ExCT compared with a traditional 12-session panic control program (PCP) for the treatment of PDA. Forty patients diagnosed as having PDA by the diagnostic criteria of DSM-IV were randomly assigned to ExCT and PCP groups of 20 patients each. The treatment effects were measured with self-report questionnaires, including the BDI, STAI, ASI, PBQ, ACQ, and BSQ. The authors also assessed high end-state functioning (HES), including the success rate of stopping or reducing medication at post-treatment and 6-month follow-up. In all ratings, both ExCT and PCP groups showed significant improvement post-treatment compared with pre-treatment scores. There were no significant differences between the two treatment groups in HES and medication discontinuation at post-treatment, but there was a significant difference in medication discontinuation at 6-month follow-up. These results suggested that although short-term effectiveness of ExCT might be comparable to the effectiveness of PCP, long-term effectiveness of ExCT might be relatively inferior to the effectiveness of PCP.     

Massed vs. spaced exposure sessions in the treatment of agoraphobia

The differential effects of massed and spaced sessions of exposure in vivo were investigated with 11 agoraphobics in a crossover design. Clients were randomly assigned to one of the following two groups: (a) 10 daily sessions followed by 10 weekly sessions, or (b) 10 once-weekly sessions followed by 10 daily sessions. The results indicated that both massed and spaced sessions of exposure in vivo effected changes in avoidance behavior and subjective anxiety of agoraphobics, massed practice being superior especially with respect to avoidance. It was suggested that the superiority of massed practice is due to the lack of opportunity to engage in avoidance or escape during short inter-session intervals. The relationship between subjective anxiety and avoidance were considered and the differences between clinical and statistical significance were discussed.     

A Dose-Ranging Study of Behavioral and Pharmacological Treatment in Social Settings for Children with ADHD

Placebo and three doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modification (no behavioral modification, NBM; low-intensity behavioral modification, LBM; and high-intensity behavior modification, HBM) in the context of a summer treatment program (STP). Participants were 48 children with ADHD, aged 5–12. Behavior was examined in a variety of social settings (sports activities, art class, lunch) that are typical of elementary school, neighborhood, and after-school settings. Children received each behavioral condition for 3 weeks, order counterbalanced across groups. Children concurrently received in random order placebo, 0.15 mg/kg/dose, 0.3 mg/kg/dose, or 0.6 mg/kg/dose MPH, 3 times daily with dose manipulated on a daily basis in random order for each child. Both behavioral and medication treatments produced highly significant and positive effects on children’s behavior. The treatment modalities also interacted significantly. Whereas there was a linear dose–response curve for medication in NBM, the dose–response curves flattened considerably in LBM and HBM. Behavior modification produced effects as large as moderate doses, and on some measures, high doses of medication. These results replicate and extend to social-recreational settings previously reported results in a classroom setting from the same sample (Fabiano et al., School Psychology Review, 36, 195–216, 2007). Results illustrate the importance of taking dosage/intensity into account when evaluating combined treatments; there were no benefits of combined treatments when the dosage of either treatment was high but combination of the low-dose treatments produced substantial incremental improvement over unimodal treatment.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period.Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patient's internal fear model and the content of exposure enhances long term treatment efficacy.     

Effects of two treatment techniques on delay and vigilance tasks with attention deficit hyperactive disorder (ADHD) children.

In this study, we examined the effects of two treatment techniques under on-medication and off-medication conditions on the hyperactive behavior patterns of children. Three groups of subjects were compared: a control group, a behavior modification group, and a cognitive training group. The Gordon Diagnostic System (Gordon, McClure, & Post, 1986) was used to assess the subjects at the initial screening, during treatment without medication, and during treatment with medication. The two medication conditions were counterbalanced during the second and third testing sessions. Results showed that when the cognitive intervention was combined with medication, there was a significant improvement in the subjects' ability to delay impulsive responding. However, no significant effects were seen for sustained vigilance for either the behavioral or cognitive groups. Parents rated children in the cognitive group significantly higher than those in the control group.