A BRIEF COMPONENT ANALYSIS OF POTENTIAL TREATMENT PACKAGES IN AN OUTPATIENT CLINIC SETTING WITH YOUNG CHILDREN

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.     

USE OF TEXTURE FADING IN THE TREATMENT OF FOOD SELECTIVITY

Children with feeding disorders often display severe food selectivity. For many of these children, consuming highly textured foods may be aversive or potentially dangerous because of frequent gagging. The purpose of this study was to demonstrate the efficacy of texture fading in the treatment of food selectivity displayed by 4 children. Treatment involved the gradual addition of higher textures based on the results of periodic probes. In addition, food acceptance and swallowing were reinforced, while food refusal and food expulsion were placed on extinction. Results showed that all participants successfully advanced to consumption of age-appropriate texture and volume. The results suggest that texture fading with intermittent probes at higher textures may be an effective method for the treatment of food selectivity by texture.     

DEVELOPMENT OF THE PARENT‐CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS

The Parent‐Child Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother–infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother–child interactions during 10 min of videotaped free‐play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test‐retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver‐Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother–infant/toddler difficulties and to monitor changes following therapy.     

A COMPARISON OF SENSORY INTEGRATIVE AND BEHAVIORAL THERAPIES AS TREATMENT FOR PEDIATRIC FEEDING DISORDERS

We compared the effects of escape extinction (EE) plus noncontingent reinforcement (NCR) with sensory integration therapy as treatment for the feeding problems of 2 children. Results indicated that EE plus NCR was more effective in increasing acceptance, decreasing inappropriate behavior, and increasing amount consumed relative to sensory integration for both children. The results are discussed in terms of the challenges of evaluating sensory‐integration‐based treatments, and the reasons why component analyses of multicomponent treatments like sensory integration are important.     

TREATMENT INTEGRITY IN APPLIED BEHAVIOR ANALYSIS WITH CHILDREN

Functional analysis of behavior depends upon accurate measurement of both independent and dependent variables. Quantifiable and controllable operations that demonstrate these functional relationships are necessary for a science of human behavior. Failure to implement independent variables with integrity threatens the internal and external validity of experiments. A review of all applied behavior analysis studies with children as subjects that have been published in the Journal of Applied Behavior Analysis between 1980 and 1990 found that approximately 16% of these studies measured the accuracy of independent variable implementation. Two thirds of these studies did not operationally define the components of the independent variable. Specific recommendations for improving the accuracy of independent variable implementation and for defining independent variables are discussed.     

USING A FADING PROCEDURE TO INCREASE FLUID CONSUMPTION IN A CHILD WITH FEEDING PROBLEMS

Stimulus fading was combined with differential reinforcement and extinction to increase intake of a calorie‐dense fluid by a 6‐year‐old child with feeding problems. The fading procedure consisted of adding Carnation Instant Breakfast? Final acceptance and then milk to water (a fluid the child would drink).     

USE OF LATENCY TO PROBLEM BEHAVIOR TO EVALUATE DEMANDS FOR INCLUSION IN FUNCTIONAL ANALYSES

Few direct‐assessment procedures are designed to identify potential negative reinforcers (e.g., including demands in the escape condition of functional analyses). Two participants were systematically exposed to a series of demands nominated by caregivers as potential negative reinforcers. Sessions ended following the first instance of problem behavior, and a hierarchy of demand aversiveness was created based on the latency to the first problem behavior. Subsequent functional analyses confirmed the predictive value of the hierarchy, with shorter latency demands consistently producing more differentiated functional analysis outcomes.     

LONG-TERM FOLLOW-UP OF A BEHAVIORAL TREATMENT FOR STUTTERING IN CHILDREN

We report 3.5-year follow-up data from children who participated in a study that evaluated a behavioral treatment for stuttering. Six of 7 subjects continued to be at or below the criterion of 3% stuttered words. Stuttering increased for 1 subject, but remained far below his baseline level. Social validity data are also reported.     

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.     

USE OF CHAINING TO INCREASE COMPLEXITY OF ECHOICS IN CHILDREN WITH AUTISM

Echoics are a critical target of language intervention for children with autism, because a well‐established echoic repertoire on the part of the child allows the clinician to use vocal modeling as a flexible, low‐effort prompting procedure during teaching. In this study, we implemented a chaining procedure to increase the complexity of echoics in 2 children with autism and 1 child with developmental delay. The procedure was effective for all 3 participants, and gains were maintained after treatment was withdrawn in most cases.     

ANALYSIS OF A SIMPLIFIED TREATMENT FOR STUTTERING IN CHILDREN

We investigated the effectiveness of a simplified program for the treatment of stuttering in children. The simplified treatment included awareness training, in which the subjects learned to detect every occurrence of stuttering; training a response incompatible with stuttering, which involved relaxation and regulation of air flow over the larynx when speaking; and social support, which involved parent-delivered prompts and praise of children's use of the techniques in everyday environments. Eight children were treated in their homes with the simplified treatment, in a multiple baseline across subjects design, and all reached the criterion level of less than 3% words stuttered. In addition, the reduction in stuttering generalized to the school setting and was maintained at posttreatment (10 to 13 months). The subjects' rates of speech remained stable throughout baseline and treatment. Pretreatment and posttreatment ratings by the parents showed that they found treatment to be both acceptable and credible. Finally, social validity measures revealed a noticeable improvement in the subjects' speech to parents and speech pathologists.     

TEACHERS' GENERALIZED USE OF DELAY AS A STIMULUS CONTROL PROCEDURE TO INCREASE LANGUAGE USE IN HANDICAPPED CHILDREN

In Experiment 1, classroom teachers were taught to delay their offers of help in naturally occurring situations, and thereby to provide additional opportunities for language use by six moderately retarded language-delayed children. The teachers introduced this delay technique in a multiple-baseline design across the six children. As delays were used, child verbal initiations increased. Follow-up assessment showed that teachers were maintaining greater than baseline levels of the delay technique after 10 weeks. Experiment 2 replicated the findings of Experiment 1, and included a more thorough maintenance assessment, while focusing on teachers' generalization of the delay technique. Teachers were found to generalize their use of delay to 56% of their monitored untaught opportunities. The two experiments show that (a) the delay technique is quick to teach and simple to implement, (b) delays do provide opportunities for children to initiate, (c) teachers can generalize their use of delay to novel self-selected situations, and (d) teachers can maintain their use of delays over time.     

AN ALTERNATING TREATMENT COMPARISON OF ORAL AND TOTAL COMMUNICATION TRAINING PROGRAMS WITH ECHOLALIC AUTISTIC CHILDREN

An alternating treatment comparison was conducted of the relative effectiveness of oral and total communication training models for teaching expressive labeling skills to three echolalic autistic children. The results of this comparison demonstrated that total communication proved to be the most successful approach with each of the subjects. In addition, the replication of these findings both within and across subjects suggest that total communication may be, in general, the most effective of these two training models for teaching basic vocal language skills to echolalic children. A number of hypotheses are presented that may provide a basis for the demonstrated effect.     

THE USE OF NONCONTINGENT ESCAPE TO REDUCE DISRUPTIVE BEHAVIORS IN CHILDREN WITH SPEECH DELAYS

Noncontingent escape (NCE) was used to reduce disruptive behavior in 3 children during regularly scheduled speech therapy sessions. Results showed rapid decreases in disruptive behavior and accompanying increases in compliance across children. Findings suggest that speech therapists with little expertise in behavior analysis can effectively implement NCE.     

PYRAMIDAL STAFF TRAINING IN THE EXTENSION OF TREATMENT FOR SEVERE BEHAVIOR DISORDERS

We implemented a pyramidal training procedure for staff working with individuals who exhibited self-injurious behavior (SIB), aggression, and disruption. Two adults with developmental disabilities and their direct-care staff and supervisors participated. Following successful treatment by the experimenters, two types of baselines were conducted with the clients and their direct-care staff. During an initial baseline, the staff implemented preexisting procedures. Staff members then received instruction on the new treatment procedures using training methods common throughout the institution, and data were collected during this “post-in-service” baseline. Experimenters then taught unit supervisors to implement treatment, collect and interpret data, and provide similar instructions and feedback to the staff members. The supervisor training was implemented in a multiple baseline design across subjects (clients and direct-care staff). Results showed little change following in-service training but noticeable improvements in direct-care staff behaviors and corresponding decreases in the clients' inappropriate behavior following the pyramidal training intervention with supervisors. Six additional clients (along with their direct-care staff and supervisors) participated in pre- and posttreatment replication designs, and their results provided additional support for the efficacy of the supervisor training procedures.     

EFFECTS OF HIGH-PROBABILITY REQUESTS ON THE ACQUISITION AND GENERALIZATION OF RESPONSES TO REQUESTS IN YOUNG CHILDREN WITH BEHAVIOR DISORDERS

The failure to respond to requests in young children often is maintained by the reactions of the adults that encounter this behavior. This failure to respond to requests has been identified as a primary reason for the children's exclusion from community, social, and instructional opportunities. Numerous interventions that target the failure to respond have consisted of punishment and reinforcement procedures. More recently, antecedent interventions have focused on changing the context in which a request is delivered. In the current study, high-probability requests were provided as an antecedent to delivering a low-probability request. The requests were delivered by multiple trainers in an attempt to produce generalized appropriate responding to adults who did not use the high-probability sequence. Results showed an immediate increase in appropriate responding in 2 children when the intervention was delivered. In addition, when the intervention was implemented by more than one adult, spontaneous increases in responding also were observed toward adults who had never implemented the request sequence. Improvements in responding to requests were maintained after the intervention was discontinued.     

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.     

THE APPLICATION OF NATURALISTIC CONVERSATION TRAINING TO SPEECH PRODUCTION IN CHILDREN WITH SPEECH DISABILITIES

The purpose of this experiment was to test the effectiveness of including speech production into naturalistic conversation training for 2 children with speech production disabilities. A multiple baseline design across behaviors (target phonemes) and across subjects (for the same phoneme) indicated that naturalistic conversation training resulted in improved spontaneous speech production. The implications of these findings are discussed relative to existing models of speech production training and other aspects of communication disorders.     

BRIEF HIERARCHICAL ASSESSMENT OF POTENTIAL TREATMENT COMPONENTS WITH CHILDREN IN AN OUTPATIENT CLINIC

Seven parents conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.