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.     

Efficacy of functional analysis for informing behavioral treatment of inappropriate mealtime behavior: A systematic review and meta‐analysis

Children diagnosed with a feeding disorder often exhibit inappropriate mealtime behavior such as throwing or swiping food, which can exacerbate feeding difficulties during treatment. We conducted a meta‐analysis of 86 behavioral treatments for inappropriate mealtime behavior from 23 studies to assess the extent to which treatments based on a pretreatment functional analysis were more efficacious than those treatments not based on a functional analysis. Procedural escape extinction and attention extinction for inappropriate mealtime behavior, as well as differential reinforcement for food acceptance or consumption, represented the most common treatments independent of whether a functional analysis was conducted. No difference was detected between treatments that were and were not based on a functional analysis, and mean effect size across measures was identical (79%). The requirement of a pretreatment functional analysis for inappropriate mealtime behavior is equivocal given that standard care often includes efficacious treatment components that are not informed by a functional analysis.     

A COMPONENT ANALYSIS OF FUNCTIONAL COMMUNICATION TRAINING ACROSS THREE TOPOGRAPHIES OF SEVERE BEHAVIOR PROBLEMS

We evaluated the separate treatment components of a functional communication training program for 3 severely handicapped persons who each displayed different topographies of aberrant behavior. Following a functional analysis of maintaining conditions for inappropriate behavior (self-injury, stereotypy, aggression), each participant was trained to emit a communicative response that functioned to solicit reinforcement. For 2 participants, consequences (time-out or graduated guidance) for inappropriate behavior were also included. Treatment continued until the participants emitted the communicative response independently and no occurrences of inappropriate behavior were observed for at least two sessions. Following treatment, the separate contributions of the treatment components for communicative responding and for inappropriate behavior were evaluated with a reversal design. The results indicated that both sets of treatment components were necessary for maximal control over aberrant behavior. These results are discussed in relation to the efficiency, history, and control over reinforcement of both appropriate and inappropriate responses.     

The application of operant conditioning techniques in a secondary school classroom

The effects of teacher praise and disapproval on two target behaviors, inappropriate talking and turning around, were investigated in a high school English class of 25 students. The contingencies were applied to all students in the experimental class utilizing a multiple baseline experimental design in which the contingencies were aimed first at decreasing inappropriate talking behavior and then at decreasing inappropriate turning behavior. Observations were made of both student and teacher behavior. The results demonstrated that the combination of disapproval for the target behaviors and praise for appropriate, incompatible behaviors substantially reduced the incidence of the target behaviors in the experimental class. Observations of these behaviors in a control class of 26 students taught by the same teacher revealed no particular changes. The findings emphasize the importance of teacher-supplied social contingencies at the secondary school level.     

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.     

A TOKEN REINFORCEMENT PROGRAM IN A PUBLIC JUNIOR-HIGH SCHOOL1

In recent years, the technology of contingency management has been shown to be of increasing value in regular classrooms and public-school systems with both groups and individual pupils (Ayllon and Roberts, Journal of Applied Behavior Analysis, 1974, 7 , 71–76; Glynn and Thomas, Journal of Applied Behavior Analysis, 1974, 7 , 299–306; Lovitt and Curtiss, Journal of Applied Behavior Analysis, 1969, 2 , 49–53; Lovitt and Smith, Exceptional Children, 1974, 40 , 357–358; Medland and Stachnik, Journal of Applied Behavior Analysis, 1972, 5 , 45–51). In addition, established procedures are being systematically replicated across grade levels and differing subject-matter areas. A series of studies initiated by O'Leary and Becker (Exceptional Children, 1967, 33 , 637–642) form the basis for the present investigation. The token reinforcement program described by O'Leary and Becker (Exceptional Children, 1967, 33 , 637–642) was managed by the teacher of an adjustment class and involved 9-yr-old children described as emotionally disturbed. An elaborate replication of the 1967 O'Leary and Becker study conducted by O'Leary, Becker, Evans, and Saudargas (Journal of Applied Behavior Analysis, 1969, 2 , 3–31) with a grade-two class introduced several variables to examine their separate effects. The authors specified their treatment levels as baseline, classroom rules, educational structure, teacher praise and ignore, token I, withdrawal, token II, and follow-up. The present research modified the general design of O'Leary et al., (Journal of Applied Behavior Analysis, 1969, 2 , 3–31) to study how to maintain treatment effects. In the modification, rules were eliminated as a treatment variable because they are frequently associated with aversive practices in the school system, and it was deemed desirable to have mainly a positive orientation. A second difference was that the present subjects were grade-nine pupils functioning in the regular public-school system. The six students were older (average age = 16.2) and well behind their peers in achievement. They were considered behavior problems and as potential dropouts by teachers and counsellors. They were not considered to be emotionally disturbed. Finally, procedures designed to maintain behavior change generated by the token system were added. The operant level of unacceptable classroom behavior was obtained for six students receiving an individualized program of instruction in mathematics and science in a nonacademic grade-nine class in a public junior secondary school. Initially, two conditions (educational structure and praising appropriate behavior while ignoring inappropriate behavior) were introduced successively. Both procedures reduced inappropriate behavior slightly. When a token system, using backup reinforcers readily available in the school, was introduced in conjunction with the initial two conditions, inappropriate responses declined dramatically in all subjects. Withdrawal of the token program for a three-week period, leaving educational structure and praising and ignoring in effect, increased inappropriate behavior in five of the six subjects. The token program was then re-introduced in conjunction with contingency contracts. The result was a decline of inappropriate behavior below the mean of the first token condition for all subjects. Tokens were thinned and finally removed toward the end of this condition, leaving teacher praise and attention and the contract system in effect. Data obtained during a four-week followup indicated that the low level of inappropriate behavior was maintained in all subjects. This extension of the O'Leary et al., (Journal of Applied Behavior Analysis, 1969, 2 , 3–31) program, designed and implemented by the regular teacher, demonstrates that these procedures may be highly effective within the constraints found in an ordinary classroom in the junior secondary school.     

SEVERE CLASSROOM BEHAVIOR PROBLEMS: TEACHERS OR COUNSELLORS

This experiment was designed to determine the relative effectiveness of teacher and counselling approaches in the reduction of disruptive or inappropriate classroom behavior. Inappropriate classroom behavior frequencies of 12 academically low achieving, seventh-grade, black male students, with a reported high rate of inappropriate classroom behavior, were recorded. Three groups, with nearly equal mean inappropriate behaviors, were randomly assigned to one of three treatment conditions: behavioral counselling, client-centered counselling, or no counselling. Each counselling group received fifteen 30-minute counselling sessions, at a rate of two to three times a week. In addition to counselling, all students subsequently received teacher approval within the classroom. Results indicated that the teacher was able to reduce inappropriate behavior more than any counselling group. There were also indications that behavioral counselling, but not client-centered counselling, was moderately helpful in reducing inappropriate classroom behavior.     

Reduction of unsafe eating in a patient with esophageal stricture.

Previous research has demonstrated the efficacy of behavioral interventions in teaching self-feeding skills as well as in reducing inappropriate self-feeding behavior. The purpose of this study was to extend previous research on the use of prompting and reinforcement in reducing unsafe eating behaviors to the treatment of an adolescent with developmental disabilities and esophageal stricture. A behavioral assessment and treatment using prompting and reinforcement were shown to be effective in decreasing bite rate, decreasing bite size, and increasing the number of chews per bite.     

A two-sample test

In certain investigations involving an experimental group and a control group, the effect of the experimental treatment may be expected to manifest itself by increasing the scores of some subjects but by decreasing the scores of other subjects. Examples arise in the area of defensive behavior. Customary tests of differences between means are inappropriate for assessing the existence of effect of the experimental treatment in such cases. A test based on the ranks of the observations is proposed; it will be sensitive to extreme scores (either large or small or both) for experimentals.     

Evaluation of a finger prompt variation in the treatment of pediatric feeding disorders

Children with feeding disorders often engage in refusal behavior to escape or avoid eating. Escape extinction combined with reinforcement is a well-established intervention to treat food refusal. Physical guidance procedures (e.g., jaw prompt, finger prompt) have been shown to increase food acceptance and decrease inappropriate mealtime behavior when more commonly employed escape extinction (e.g., nonremoval of the spoon) procedures are ineffective. The finger prompt, however, has not been extensively evaluated as a treatment adjunct to target food refusal, thus necessitating further examination. The purpose of this prospective study was to assess a variation of a finger prompt procedure to treat food refusal and to assess caregivers' acceptability of the procedure. Three children age 1 to 4 years admitted to an intensive feeding disorders program and their caregivers participated. The finger prompt was effective in increasing bite acceptance across all participants and decreasing or maintaining low levels of inappropriate behavior for 2 participants. The procedure was also acceptable to all caregivers.     

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 comparison of two multicomponent treatment packages for food refusal

Food refusal is a severe feeding problem in which children refuse to eat all or most foods, which can be treated effectively using multicomponent intervention packages. This study compared two multicomponent treatment packages on food and drink consumption, inappropriate mealtime behavior, and total intake in a child with food refusal. Bite and drink consumption was consistently higher; inappropriate mealtime behavior was consistently lower; and total intake was greater when differential reinforcement of alternative behavior and escape extinction treatment were implemented compared to response cost, escape extinction, and differential reinforcement of alternative behavior.     

Factors associated with parent labeling of children referred for conduct problems

Clinicians have suggested that in some cases normal children have been inappropriately labeled as deviant by their parents and taken to psychological clinics for treatment. Reasons given for such inappropriate labeling have included factors such as the parents' marital distress and intolerance of normal child behavior. This study provided an empirical examination of the appropriateness or inappropriateness of parent labeling of 5–12-year-old children referred by their parents for treatment of conduct problems. The definition of inappropriate labeling derived by the present investigators required that the relationship between the child's actual behavior and the parent's negative label be so imperfect as to raise questions about the justification for the label, and that some identifiable factors other than the child's behavior account for the negative label. Three parent factors evaluated for their contribution to the parent negative label were marital distress, parent negative behavior toward the child, and parent distress about child deviant behavior. The statistical model of hierarchical multiple regression permitted analysis of this definition. The association found between observed child deviant behavior and the parent negative label suggested that parents of this sample perceived their children reasonably accurately. The three parent factors were found to be negligibly related to the parent label. Therefore, the conditions for inappropriate labeling of the children by the parents of this sample were not met.     

MANAGEMENT OF INAPPROPRIATE BEHAVIORS OF TRAINABLE MENTALLY IMPAIRED STUDENTS USING ANTECEDENT EXERCISE

The effects of several levels of exercise on inappropriate behaviors of four trainable mentally impaired students were observed. Treatment conditions, which occurred as the first daily activity, included: Phase I, daily alternating conditions of warm-up exercises and jogging at a moderate rate for a short distance; Phase II, daily alternating conditions of no-exercise periods and jogging at a vigorous rate for a moderate distance; and Phase III, jogging at a vigorous rate for a moderate distance on consecutive days. For one student two additional conditions occurred, Phase IV, long-distance jogging on consecutive days at a vigorous rate and Phase V, consecutive days of no exercise. Observations of three inappropriate behaviors of each student occurred immediately after, 1 hour after, and 2 hours after each exercise period. Results indicate a decrease in all three inappropriate behaviors for three of four students and an inverse relationship between the level of exercise and the amount of inappropriate behavior for three of four students. Improvements over existing studies are discussed with suggestions for future research.     

ACCEPTABILITY OF ALTERNATIVE TREATMENTS FOR DEVIANT CHILD BEHAVIOR

The acceptability of alternative treatments for deviant child behavior was evaluated in two experiments. In each experiment, clinical cases were described to undergraduate students along with four different treatments in a Replicated Latin Square Design. The treatments included reinforcement of incompatible behavior, time out from reinforcement, drug therapy, and electric shock and the treatments were described as they were applied to children with problem behaviors. Experiment 1 developed an assessment device to evaluate treatment acceptability and examined whether treatments were rated as differentially acceptable. Experiment 2 replicated the first experiment and examined whether the severity of the presenting clinical problem influenced ratings of acceptability. The results indicated that treatments were sharply distinguished in overall acceptability. Reinforcement of incompatible behavior was more acceptable than other treatments which followed, in order, time out from reinforcement, drug therapy, and electric shock. Case severity influenced acceptability of alternative treatments with all treatments being rated as more acceptable with more severe cases. However, the strength of case severity was relatively small in relation to the different treatment conditions themselves which accounted for large portions of variance.     

Effects of using self-recording and self-observation in reducing disruptive behavior

In an attempt to reduce the levels of disruptive behavior, six participants in a school for students with behavior disorders were shown edited videotapes depicting themselves appropriately engaged in classroom activities. The participants were first exposed to a training condition in which both appropriate and inappropriate behaviors of a peer were either observed or observed and recorded. In the intervention condition, the participants either self-observed and self-recorded their behaviors from videotape or simply observed themselves on videotape. The results showed idiosyncratic effects across both conditions. Measures of treatment integrity and treatment acceptability were also conducted. The results of this study are compared with similar research investigating self-observation interventions.     

Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.