Behavioral assessment of psychiatric inpatients and normal controls across different environmental contexts

Objectively defined, publicly observable behaviors were time sampled for hospitalized psychiatric patients and normal controls in three distinct environmental contexts: lunch time, free time, and gym time. The behaviors sampled included body activity, extremity activity, proximity, social interactions, participation, visual scanning, laughing/smiling, and idiosyncratic behavior. Patient behaviors were recorded during both a drug-free baseline period and a subsequent medication period. The data suggest that consistent and reliable differences between patients and normals in most behaviors can be observed and that environmental context is an important determinant of these differences. Results are discussed in terms of their implications for assessment procedures and treatment decisions.These investigations were supported in part by State of Illinois Department of Mental Health and Developmental Disabilities Grants RD836-13 and RD622-02 to the first author. The cooperation of the Illinois State Psychiatric Institute staff is gratefully acknowledged.     

SOLITARY TOY PLAY AND TIME OUT: A FAMILY TREATMENT PACKAGE FOR CHILDREN WITH AGGRESSIVE AND OPPOSITIONAL BEHAVIOR

The behavior of four boys, 5 to 8 years of age, who were referred for a number of oppositional, rule violating, and aggressive behaviors, was assessed by direct observation and parent reports. Following baseline measurement, several interventions were successively applied to each child's behavior. Use of a social play contract to reduce problem behaviors by teaching appropriate social behaviors resulted either in no improvement or in worsening of the problem behaviors in observations made when the contract was not in effect. Changing the contract behavior to solitary toy play resulted in reduced oppositional behavior during the observation sessions, fewer reports from the parents of low-rate problem behaviors, and improvements in the parents' attitudes toward the children. However, these changes during the observation sessions were shortlived, because the data on these measures began to show a reversal during later sessions. Inclusion of a time-out contingency with the solitary play contract recovered the earlier improvements in the children's behavior during observation sessions and the parents' reports. These results gave support to the view that for children whose behavior is severely oppositional and aggressive, a treatment approach emphasizing productive, solitary behaviors may be superior to one stressing appropriate social interaction. However, a combined strategy of reinforcement for solitary play and punishment for problem behaviors appears necessary to ensure more durable treatment effects.     

Psychiatric patient and informant reports of patient behavior

Informant reports of psychiatric patient behavior are collected routinely during intake interviews and to monitor therapeutic interventions. We investigated agreement between informant and adult psychiatric patient reports of patient behaviors (N=110). Behaviors were about substance use, physical and mental health, employment, illegal behavior, and recreational and social activities. Informant agreement with patients regarding whether or not a particular behavior occurred recently and also behavior frequency ratings were moderate overall (M r=.47 for frequency) and highly variable (rs=-.09 to .80). No informant, patient, or relationship characteristics were found consistently to moderate agreement. Thus, informants can report very accurately about the presence and frequency of some, but not all, patient behaviors. Low patient-informant agreement may be due to informants having relatively less detailed knowledge of patient behavior over time or patients not reporting accurately about certain behaviors.     

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.     

Evaluating Treatments for Functionally Equivalent Problem Behavior Maintained by Adult Compliance with Mands During Interactive Play

A primary goal of behavioral interventions is to reduce dangerous or inappropriate behavior and to generalize treatment effects across various settings. However, there is a lack of research evaluating generalization of treatment effects while individuals with functionally equivalent problem behavior interact with each other. For the current study, the severe problem behavior of two participants with developmental disabilities was targeted for assessment and treatment. Results of a functional analysis indicated that for both participants, problem behaviors occurred when destructive behavior produced reinforcement of participant mands . The use of a multiple schedule that alternated between differential reinforcement of other behaviors and differential reinforcement of alternative behavior (mands) was sufficient to produce a significant reduction in problem behavior for one participant; the addition of differential reinforcement of alternative behaviors via compliance was necessary for the second participant. Extended treatment sessions, which focused on interaction between the two participants, involved one therapist concurrently implementing each participant’s treatment while they were directed to play with one another (a situation that previously evoked problem behavior). Results show that each participant’s treatment produced low to zero rates of problem behavior even during extended interactions.     

EFFECTS OF SYSTEMATIC,RESPONSE-DEPENDENT FADING AND THINNING PROCEDURES ON THE MAINTENANCE OF CHILD-CHILD INTERACTION

Previous investigations of the social behavior of handicapped preschool children (Journal of Applied Behavior Analysis, 1974, 7 , 583–590; Journal of Applied Behavior Analysis, 1976, 9 , 31–40; Journal of Applied Behavior Analysis, 1977, 10 , 289–298) demonstrated that introduction of adult or peer confederate intervention agents produced substantial increases in levels of positive social behavior emitted by the subjects. In addition, it was observed that changes in rates of positive social behavior emitted by recipients of intervention tactics were accompanied by parallel changes in rates of positive social behavior emitted by interacting peers. However, with one limited exception, sudden removals of arranged intervention procedures were followed by immediate reductions in the levels of positive social behavior emitted by subjects and peers in each study. The current investigation was designed to examine the effects of response-dependent removal of intervention procedures on the positive behavior of three socially withdrawn preschool boys. Interactive effects on the social behavior of classroom peers who did not receive adult prompts and contingent attention events were also examined. A combination of withdrawal of treatment and multiple baseline procedures was employed. The three target subjects received fixed numbers of prompts and contingent attention events during Intervention I and Intervention II, Phase 1 conditions. During Intervention II, Phase 2 conditions, prompts and contingent attention events were reduced on a response-dependent basis for two subjects and on a response-independent basis for the third subject. The results suggest that: (a) the intervention procedures produced marked increases in positive social behavior emitted by each subject; (b) response-dependent fading and thinning, contrasted with response-independent tactics, maintained levels of positive social behavior equivalent to those observed during Intervention I and Intervention II, Phase 1 conditions; (c) changes in positive and negative behaviors emitted by peers paralleled changes in positive and negative behaviors emitted by each subject; and (d) no “spillover” of treatment effects was noted for subjects during periods in which they were not direct recipients of intervention procedures.     

PILLS OR SKILLS FOR HYPERACTIVE CHILDREN

The controversial nature of drug treatment of hyperactivity, the incidence and sequelae of hyperactivity, and problems of differential diagnosis of hyperactivity versus aggression were discussed. The effects of psychostimulant medication and behavior therapy on hyperactive children were reviewed with regard to effects on their social and academic behavior. Both treatments have resulted in clear short-term changes in social behavior but neither long-term academic nor long-term social effects have been shown with either treatment. Short-term effects on academic behavior have resulted from behavioral interventions but not from psychostimulants. However, the interventions have been too brief to allow one to draw unequivocal conclusions about the clinical efficacy of behavioral treatments. Although there have been long-term evaluations of psychostimulant therapy, there have not been any evaluations of long-term behavioral treatment programs for hyperactive children. Given the salutary short-term effects of behavior therapy with hyperactive children, extended clinical trials of behavior therapy need to be conducted. Finally, specific directions are suggested for future research.     

A method for the definition of a self-awareness behavior dimension with clinical subjects: A latent trait analysis

The main scope of the present study was to devise a method in order to define a dimension characteristic of self-awareness behaviors with clinical subjects. To do so, I adopted a latent trait methodological approach. I studied the way patients expressed their treatment requests through their behaviors, both during their admission to a medical center in Northern Italy and after a period of treatment that involved an integrated (psychoanalytical and pharmacological) approach. The subjects were 48 females suffering from affective disorders, often combined with personality disorders. Five self-awareness indicators were identified, based both on interviews conducted with the patients and on the literature on the subject. The data gathered were analyzed by means of the many-facet Rasch model (Linacre, 1989). The results confirmed the existence of a self-awareness dimension characterized by the five indicators. Moreover, there was evidence that an improvement in self-awareness occurred during the pretreatment to posttreatment time period for both the affective disorders with personality problems patients and the affective disorders without personality problems patients. The estimation of bias/interactions showed the existence of specific behavioral differences between the two groups of patients. This study demonstrates the appropriateness of the methodological tool adopted, opening new expectations with regard to the integration of two approaches—psychoanalytical and pharmacological ones—in the treatment of psychiatric subjects.     

Noncontingent reinforcement, alternative reinforcement, and the matching law: a laboratory demonstration

Basic researchers, but not most applied researchers, have assumed that the behavior-decelerating effects of noncontingent reinforcement result at least partly from adventitious reinforcement of competing behaviors. The literature contains only sketchy evidence of these effects because few noncontingent reinforcement studies measure alternative behaviors. A laboratory model is presented in which concurrent schedules of contingent reinforcement were used to establish a "target" and an "alternative" behavior. Imposing noncontingent reinforcement decreased target behavior rates and increased alternative behavior rates, outcomes that were well described by the standard quantitative account of alternative reinforcement, the generalized matching law. These results suggest that adventitious reinforcement of alternative behaviors can occur during noncontingent reinforcement interventions, although the range of conditions under which this occurs remains to be determined in future studies. As an adjunct to applied studies, laboratory models permit easy measurement of alternative behaviors and parametric manipulations needed to answer many research questions.     

DISCUSSION: USING PEERS TO INCREASE BEHAVIORS OF ISOLATED CHILDREN IN SCHOOL SETTINGS: AN ANALYSIS OF GENERALIZATION EFFECTS

This review evaluates the effectiveness of peer mediation in increasing the social behaviors of isolated children in school settings. Studies indicate that peer assisted interventions can produce increases in social behavior and the generalization of treatment effects across a variety of situations. Discussion also focuses on ethical considerations when peers serve as behavior change agents, maximizing generalization effects, and suggestions for future research.     

MULTIPLE-BASELINE ANALYSIS OF A TOKEN ECONOMY FOR PSYCHIATRIC INPATIENTS

Twelve behaviors selected for reinforcement among 16 chronic psychiatric inpatients were divided into four classes: (a) personal hygiene, (b) personal management, (c) ward work, and (d) social skills. A token economy program was introduced for each class in a sequential, cumulative, multiple-baseline format. Corrections were included for methodological deficiencies frequently encountered in past studies. Treatment variables were systematically monitored, and target behavior rates, levels of global individual functioning, general ward behavior, and off-ward behavior were assessed during baseline, implementation, and probe periods. Results indicated abrupt and substantial increases in performance of most target behaviors, significant improvements in global individual functioning (p < .025), positive changes in general ward behavior, and increases in social interaction during off-ward activities. The findings provide strong evidence for the efficacy of a token economy and indicate that the multiple-baseline design can be a useful method for evaluating token economy programs.     

Psychopathology of Adolescent Social Phobia

Sixty-three adolescents with social phobia and 43 with no psychiatric disorders were compared across a number of clinical variables. In addition to clinically impairing social fear, adolescents with social phobia had significantly higher levels of loneliness, dysphoria, general emotional over-responsiveness and more internalizing behaviors than normal controls and 57.1% of socially phobic adolescents had a second, concurrent diagnosis, 75% of which were other anxiety disorders. In addition, adolescents with social phobia were significantly less socially skilled. Though similar in some respects to childhood social phobia, adolescent social phobia has a unique clinical presentation. The importance of developmental differences on the development of age-appropriate interventions is discussed.     

A Comparison of Video Feedback and In Vivo Self-Monitoring on the Social Interactions of an Adolescent with Asperger Syndrome

Difficulties with social interactions and restrictive and repetitive interest patterns or behaviors are common among individuals with Asperger syndrome. These difficulties often pose barriers to establishing and maintaining social relationships. In the current study, 2 different interventions were compared that focused on improving the social interactions of a 14-year-old adolescent with Asperger syndrome. A reversal design was used to compare the effectiveness of video feedback and in vivo self-monitoring on inappropriate and appropriate social interactions during activities with a teacher. The procedures were replicated during activities with peers, and generalization was assessed during activities with the adolescent’s mother. Although video feedback resulted in slight reductions in inappropriate behavior, larger reductions occurred during in vivo self-monitoring. Treatment acceptability data indicated high participant satisfaction with both interventions; however, the in vivo self-monitoring was rated as slightly preferred.     

Modification of preschool sex-typed behaviors by participation in adult-structured activities

Earlier studies have shown the girls spend more time than boys in activities that are highly structured by adults. Structured activities may encourage feminine sex-typed behaviors such as compliance to adults; low-structure activities may encourage masculine sex-typed behaviors such as independence and assertiveness. In the present study the effects of high or low levels of adult structuring on children's social behavior during preschool free-play activities were tested in a field experiment carried out during an entire semester in one preschool classroom. For the first 15 minutes of free play, children were assigned to high- or low-structure activities. As predicted, when children were in high-structure activities, they exhibited high rates of bids for recognition and compliance to adults; in low-structure activities, they exhibited peer-directed leadership, bids for recognition, and compliance. There were no generalized effects of these treatments on their subsequent free choice of activities or social behavior. The study demonstrates powerful effects of naturally occurring variations in children's play activities on sex-typed social behaviors.     

Suicidal behavior inLatinas: explanatory cultural factors and implications for intervention

We posit that the high rates of suicidal behavior by teenage Hispanic females reported in large-scale surveys can be understood as a cultural phenomenon, a product of specific elements of the history, tradition, ideology, or social norms of a particular society, and that treatment interventions must take family and cultural factors into consideration. For over a decade, surveys have reported that among ethnic and racial minority youth in the United States, Latinas have the highest rates of suicidal behavior compared to African American and non-Hispanic White adolescent females. However, other research shows that the psychological profiles of suicidal Latina adolescent girls and the risk factors for Latina suicidal behavior may not be that different from non-Hispanic suicidal adolescent females. The unique situation of adolescent Latinas involves the convergence of cultural and familial factors (i.e., familism, acculturation, relatedness, autonomy, etc.) with the developmental, social, and individual factors frequently associated with suicidal behaviors. Based on this background, family-oriented interventions appear to be the most appropriate approach to the prevention and treatment of Hispanic suicidal girls. Factors implicated in Latina suicidal behavior and community-based interventions that include the adolescent and her family are suggested.     

Self-Monitoring of Attention Versus Self-Monitoring of Performance: Examining the Differential Effects Among Students with Emotional Disturbance Engaged in Independent Math Practice

Although students with emotional disturbance are commonly known for their social behavior deficits, they often have academic deficits as well. Unfortunately, most of the intervention research and many of the practices used with this population focus upon their social behavior deficits and fail to recognize the need to improve their academic skills. Therefore, there is a need for identifying research-based interventions that focus on ameliorating social and academic deficits often exhibited by students with emotional disturbance. The purpose of this study was to examine the differential effects of self-monitoring of attention versus self-monitoring of performance on the academic and social behaviors of three minority students identified as having emotional disturbance while independently engaged in practicing mathematical calculations. The findings suggest that students with emotional disturbance may perform better socially and academically during math practice while self-monitoring their academic performance. Social validity data also suggest that students rated self-monitoring of academic performance more favorably than self-monitoring of attention. In addition, all target students in this study exhibited levels of on-task behavior more similar to their peers while self-monitoring academic performance compared to self-monitoring attentive behavior.     

EFFECTS OF SPACED RESPONDING DRL ON THE STEREOTYPED BEHAVIOR OF PROFOUNDLY RETARDED PERSONS

Stereotypic responding and social behaviors of three profoundly retarded children were measured before and during application of a DRL contingency for stereotypic responding. A variant of the standard DRL procedure, spaced responding DRL, was used, in which reinforcement is delivered following a response if that response has been separated from the previous response by at least a fixed minimum time interval. Three children were treated by using a reversal design. Results showed that: (a) during baseline sessions, the children engaged in high rates of stereotypic responding and very low rates of appropriate social behavior; and (b) during DRL sessions, appropriate behavior increased markedly as stereotypic responding was reduced. The data suggest that spaced responding DRL may be effective in increasing appropriate social behavior as well as in reducing stereotypic responding.     

Behavior modification with culturally deprived school children: two case studies

Techniques of behavior modification were employed with two second-grade Negro girls in a demonstration school for culturally deprived children to increase the girls' appropriate classroom behaviors. A classification system that provided for continuous categorization of behavior was used to code the children's behavior in two classroom situations. Data were also taken on the type, duration, and frequency of the teachers' verbal interactions. The study included four conditions: Baseline, Modification I, Postmodification, and Modification II. The treatment variable was positive social reinforcement-attention and approval contingent upon desirable classroom behaviors-which was presented, withheld, or withdrawn (timeout from social reinforcement). Withholding of social reinforcement was contingent upon inappropriate attention-getting behaviors. Timeout from social reinforcement was contingent upon behaviors classified as aggressive and resistive. After 25 days of Modification I, desirable behavior increased markedly for each girl. The teachers were then asked to return to their Baseline level of performance. The resultant behaviors demonstrated that for one girl, behavior was still primarily under the control of the treatment contingencies. For the second child, many desirable behaviors that had increased in frequency during Modification I remained high, but inappropriate behaviors increased. When treatment was reinstated, the amount of time spent in desirable behaviors increased and remained high for both girls. Three checks during the three months following data collection showed that these behaviors continued to remain high.     

A systematic review of psychoneuroimmunology-based interventions

Psychoneuroimmunology-based interventions are used to attenuated disease progression and/or side effects of pharmacological treatment. This systematic review evaluates the different therapeutic and/or clinical psychoneuroimmunology-based interventions associated to both psychological, neuroendocrine and immunological variables. The review was conducted for all English, Portuguese and Spanish language articles published between 2005 and 2015. Independent investigators analyzed 42 studies concerning human psychoneuroimmunology-based interventions. Decreased levels of cortisol, epinephrine and norepinephrine (stress-related hormones) were associated to interventions like yoga, meditation, tai chi, acupuncture, mindfulness, religious/spiritual practices, cognitive behavior therapy, coping and physical exercises. Moreover, those interventions were also associated to reductions in inflammatory processes and levels of pro-inflammatory cytokines in cancer, HIV, depression, anxiety, wound healing, sleep disorder, cardiovascular diseases and fibromyalgia. Despite the associations between PNI variables and clinical/therapeutic interventions, only one study evidenced significant effects on a disease progression.