Temperament and behavior of infants prenatally exposed to drugs: Clinical implications for the mother-infant dyad

In trying to prevent developmental delays, we are continually searching for specific events or factors that are responsible for less than optimal development. Recept attention has focused on the effects of cocaine exposure in utero, with the most common effects appearing to be subtle neurobehavioral differences. The purpose of this study was to determine if, at the age of 6 months, infants exposed to cocaine exhibit significant differences in behavior and cognitive abilities. Results of this study revealed differences between exposed and nonexposed infants in both temperament and behavioral characteristics. Temperamentally, children prenatally exposed to cocaine were reported to be less cooperative, more difficult to manage, and more arrhythmic. The drug-exposed group was also rated lower on behavioral characteristics of responsiveness, communication, and participation. The two groups were similar in terms of cognitive development. The impact of these behavioral effects on the mother-infant relationship is discussed in terms of clinical and research implications of this study.     

Benefits of adding precision teaching to behavioral interventions for students with autism

Students with autism have a variety of learning characteristics that can provide challenges to teachers. Precision Teaching, a method providing frequent assessment of performance, facilitation of curricular decisions, and techniques for developing fluency, can help teachers enhance educational outcomes for students with autism. Teachers can use the techniques found in Precision Teaching to augment their current instructional methods. This article purposes to examine the potential benefits of adding Precision Teaching to behavioral interventions for children with autism. This paper will define Precision Teaching, and review its guidelines within the context of a hypothetical case study. Copyright © 2002 John Wiley & Sons, Ltd.     

Reactivity and regulation in children prenatally exposed to cocaine

Children prenatally exposed to cocaine may be at elevated risk for adjustment problems in early development because of greater reactivity and reduced regulation during challenging tasks. Few studies have examined whether cocaine-exposed children show such difficulties during the preschool years, a period marked by increased social and cognitive demands and by rapid changes in reactivity and regulation. The authors addressed this question by examining frustration reactivity and regulation of behavior during a problem-solving task in cocaine-exposed and -unexposed preschoolers. Participants were 174 4.5-year-olds (M age = 4.55 years, SD = 0.09). Frustration reactivity was measured as latency to show frustration and number of disruptive behaviors, whereas regulation was measured as latency to approach and attempt the problem-solving task and number of problem-solving behaviors. Results indicated that cocaine-exposed children took longer to attempt the problem-solving task but that cocaine-exposed boys showed the most difficulties: They were quicker to express frustration and were more disruptive. Effect sizes were relatively small, suggesting both resilience and vulnerabilities.     

Altered grooming responses to stress in rats exposed prenatally to ethanol

The effects of prenatal alcohol exposure on grooming, locomotion, and rearing in response to stress were examined in adult rats whose mothers consumed a liquid diet containing 35% ethanol-derived calories (EDC). Offspring of both pair-fed 0% EDC mothers and ad libitum chow-fed mothers were included as controls. In Experiment 1, females groomed more than males following placement into a novel test chamber, but no differences due to prenatal treatment were observed. Ethanol-exposed animals groomed more than controls following the stress of a forced 1-min swim (Experiment 2), but when rats tested in Experiment 1 were observed again after forced swim stress (Experiment 3), no differences due to prenatal treatment or sex were observed. Experiment 4 examined the effects of pretreatment with 1 mg/kg naloxone on novelty-induced grooming and as in Experiment 1 prenatal treatment did not affect grooming responses. Females again groomed significantly more than males and naloxone reduced grooming equally for all groups. The results suggest that novelty-induced grooming is a sex-influenced behavior, with females grooming more than males, and that animals exposed prenatally to alcohol and tested as adults may have altered responses to certain stressors (i.e., forced swim) under specific conditions. The altered grooming response of alcohol-exposed rats to swim stress can be eliminated by preexposing them to novelty stress.     

Memory and brain volume in adults prenatally exposed to alcohol

The impact of prenatal alcohol exposure on memory and brain development was investigated in 92 African-American, young adults who were first identified in the prenatal period. Three groups (Control, n=26; Alcohol-related Neurodevelopmental Disorder, n=36; and Dysmorphic, n=30) were imaged using structural MRI with brain volume calculated for multiple regions of interest. Memory was measured using the Verbal Selective Reminding Memory Test and its nonverbal counterpart, the Nonverbal Selective Reminding Memory Test, which each yielding measures of learning and recall. For both Verbal and Nonverbal Recall and Slope, linear trends were observed demonstrating a spectrum of deficits associated with prenatal alcohol exposure. Dysmorphic individuals performed significantly poorer than unexposed controls on 5 of 6 memory outcomes. Alcohol-exposed individuals demonstrated significantly lower total brain volume than controls, as well as lower volume in a number of specific regions including hippocampus. Mediation analyses indicated that memory performance associated with effects of prenatal alcohol exposure was mediated from dysmorphic severity through hippocampal volume, particularly right hippocampus. These results indicate that the association between the physical effects of prenatal alcohol exposure and deficits in memory are mediated by volumetric reduction in specific brain regions.     

Executive function in preschool children prenatally exposed to methadone or buprenorphine

Although an increasing number of children are born with prenatal methadone or buprenorphine exposure, little is still known about the potential long-term effects of these opioids. The aim of this study was to investigate executive function (EF) in children of women in opioid maintenance therapy (OMT). A total of 66 children (aged 48–57 months) participated in the study, 35 of which had histories of prenatal methadone or buprenorphine exposure. EF was measured using a battery of neuropsychological tests and the Behavior Rating Inventory of Executive Function—Preschool Version (BRIEF-P). Results showed that children of women in OMT perform lower on tasks of short-term memory and inhibition compared to nonexposed children, which was mainly associated with lower maternal education and employment rate. The OMT group scored significantly lower on all EF tasks compared to the nonexposed group, although scores fell within the average range on all measures. The development of these children should be monitored to assess for the possible problem behaviors and to promote optimal outcomes.     

A universal behavioral screener linked to personalized classroom interventions: Psychometric characteristics in a large sample of German schoolchildren

The current study represents the first psychometric evaluation of an American English into German translation of a school-based universal screening measure designed to assess academic and disruptive behavior problems. This initial study examines the factor structure and diagnostic accuracy of the newly translated measure in a large sample of 1009 German schoolchildren attending grades 1–6 in Western Germany. Confirmatory factor analysis supported a two-factor model for both male- and female- students. Configural invariance was supported between male- and female-samples. However scalar invariance was not supported, with higher thresholds for ratings of female students. Results of receiver operating characteristic (ROC) curve analyses were indicative of good to excellent diagnostic accuracy with areas under the curve ranging from 0.89 to 0.93. Optimal cut-off scores were 10, 5, and 13 for the Academic Productivity/Disorganization, Oppositional/Disruptive, and the Total Problems Composite scores of the Integrated System Teacher Rating Form respectively. This initial study of the newly translated measure supports further investigations into its utility for universal screening in German speaking schools.     

A behavioral approach to the control of thumbsucking in the classroom

The purpose of the present study was to determine whether classroom thumbsucking could be controlled by making social reinforcement contingent upon appropriate behaviors incompatible with thumbsucking. The classroom thumbsucking behavior of three 8-yr-old elementary school children was observed and recorded by two observers. Sixteen experimental lessons were divided into sets of baseline, reinforcement, reversal, and representation of reinforcement. The effect of the experimental treatment was determined by the changes in the total thumbsucking level for each subject during each lesson. Results indicated noticeable decreases in thumbsucking rate for all three subjects during lessons in which social reinforcement was made contingent upon appropriate behavior. Two of the three subjects showed sudden increases in thumbsucking time during lessons when social reinforcement for appropriate responses was withheld; the third subject showed continued low thumbsucking time during these lessons.     

Training behavioral technicians to implement naturalistic behavioral interventions using behavioral skills training

Training behavioral technicians mainly focuses on teaching accurate implementation of structured behavioral intervention programs. Often behavioral technicians are unable to adequately promote their clients' learning in less structured environments, which can limit opportunities for generalization of the clients' skills to the natural environment. The aim of the present study was to evaluate the effectiveness of using behavioral skills training to coach behavioral technicians on the implementation of naturalistic behavioral interventions. Naturalistic behavioral interventions take advantage of naturally occurring situations to teach new skills and practice mastered skills in natural settings, thus promoting generalization across environments and in the presence of natural contingencies. Five behavioral technicians were trained to implement a novel protocol based on play therapy. Specifically, they were coached to engage in well‐defined positive behaviors during their interactions with clients (e.g., labeled praise). All participants reached mastery criteria, maintained skills at follow‐up, and demonstrated generalization of skills with novel clients.     

Children prenatally exposed to maternal anxiety devote more attentional resources to neutral pictures

Maternal anxiety during pregnancy can negatively affect fetal neurodevelopment, predisposing the offspring to a higher risk of behavioral and emotional problems later in life. The current study investigates the association between maternal anxiety during pregnancy and child affective picture processing using event‐related brain potentials (ERPs). Mothers reported anxiety during the second trimester using the anxiety subscale of the Symptom Checklist (SCL‐90). At age 4 years, child affective picture processing (N = 86) was measured by recording ERPs during viewing of neutral, pleasant, and unpleasant pictures selected from the International Affective Pictures System. The late positive potential (LPP)—an ERP component reflecting individual differences in affective processing—was used as child outcome. The expected positive association between maternal anxiety and LPP amplitude for unpleasant pictures was not found. Nevertheless, we found a positive association between maternal anxiety during pregnancy and LPP amplitudes for neutral pictures in the middle and late time window at anterior locations (all p < .05). These associations remained significant after adjusting for maternal postnatal anxiety and gestational age at birth and after FDR correction for multiple comparisons. Our study provides neurophysiological evidence that children prenatally exposed to higher maternal anxiety devote more attentional resources to neutral pictures, but not to unpleasant pictures. Possibly, these children show enhanced vigilance for threat when viewing neutral pictures. Although useful in dangerous environments, this enhanced vigilance may predispose children prenatally exposed to higher maternal anxiety to developing behavioral and/or emotional problems later in life. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=kEzYi6IS2HA     

In vivo functional assessment and multi-element interventions for problem behaviors of students with disabilities in classroom settings

Persons with developmental disabilities often do not follow instructions or complete tasks in educational settings, thus further disadvantaging themselves as they try to lead more normalized lives. The purpose of this paper was to address the problems of three persons referred for not following instructions and for engaging in associated behavior problems (e.g., crying, hitting, throwing materials) when given instructions. A functional assessment was conducted in the natural school setting without any prescribed conditions as in analogue functional assessments. Results of the assessments showed that problem behaviors for two subjects occurred much more in demand conditions requiring active responses than in demand conditions requiring passive responses. The results for a third subject showed problem behaviors were associated with toileting demands, less so with other demand conditions, but not with conditions in which there were an absence of demands. Individualized multi-element interventions were based on the negative reinforcement hypothesis and were intended to make tasks less aversive and to make instructions easier to understand. Results of the interventions showed increases in task engagement and decreases in problem behaviors during the active tasks and toileting tasks for which interventions were programmed, as well as for the passive tasks and other demand conditions for which no interventions were programmed. Results were discussed in terms of the value of functional assessments in directing therapists to base interventions on hypotheses of the function of the presenting problem.     

A review of behavioral interventions to enhance sports performance

Research on applied behavior analysis and sports performance has become an increasingly popular subject. It involves using behavioral measures to assess the utility of numerous interventions to enhance athletic performance. We identified 101 studies published since the late 1960s focusing on behavioral interventions to enhance sports performance. To determine the breadth of the current research, we identified each sport and the different interventions used to improve performance. Of the studies included in this review, research has investigated 23 interventions with 21 sports. The purpose of this paper is to review the current literature regarding what procedures have been evaluated, the results of this research, some of the limitations, and future directions of behavioral research on sports performance enhancement. In doing so, this review will allow readers to easily browse the current literature by the sport or intervention of interest.     

Telling tales in school: extended contact interventions in the classroom

Extended contact has demonstrated its effectiveness in promoting more positive intergroup attitudes among children in previous experimental research. The current project evaluates the use of extended contact interventions involving story‐telling in two novel school settings: the United States (N = 213) and Italy (N = 222) among children aged 5–12 years. Findings indicate support for the effectiveness of the interventions in these two locations among younger minority and majority children but call into question the durability of positive outcomes. Applications and implications are discussed.     

Psychostimulant effects on academic and behavioral measures for ADHD junior high school students in a lecture format classroom

This study evaluated the effects of two doses of psychostimulants on nine ADHD students' performance in a classroom designed to be analogous to a junior high school American history class conducted during a summer treatment program. Double-bline, placebo-controlled assessment revealed significant and clinically important effects of psychostimulants on quiz and test performance, observations of attention and behavior during lectures, and teacher ratings, as well as accuracy on assignments completed during study hall. Analysis of individual differences revealed a 66% positive response rate. The implications for use of psychostimulants with ADHD young adolescents are discussed.This research was conducted while the second author was supported in part by grants from the National Institute on Alcohol Abuse and Alcoholism (AA06267) and the National Institute on Drug Abuse (DA 05605). This study was conducted during the 1989 Summer Treatment Program (STP) conducted by the Attention Deficit Disorder Program at the Western Psychiatric Institute and Clinic. We thank WPIC for its support, as well as the ADD and STP program staffs for their helpful cooperation, particularly Kelly Davis, Karen Greenslade, Vincent Grudberg, Gray Vallano, and Mary Vodde-Hamilton.     

Using behavioral skills training with preservice teachers in the university classroom

Preservice and novice teachers often identify behavior management as an area of weakness that they attribute to a lack of sufficient instruction during their teacher preparation. Behavioral skills training (BST) is an evidence‐based teaching methodology based on the principles of applied behavior analysis used to teach new skills. This study investigated the use of BST in the university setting to teach undergraduate preservice teachers enrolled in a field‐based special education course to implement a token economy during small group instruction with children. A single‐case research design was used to assess the effectiveness of using BST by evaluating accuracy of implementation before and after BST. Results showed BST was an effective teaching procedure and social validity measures collected from the preservice teachers indicated BST was acceptable to all participants. Limitations and needs for future research are discussed.     

Five direct behavior rating multi-item scales: Sensitivity to the effects of classroom interventions

Direct Behavior Rating (DBR) is a tool designed for the assessment of behavioral changes over time. Unlike methods for summative evaluations, the development of progress monitoring tools requires evaluation of sensitivity to change. The present study aimed to evaluate this psychometric feature of five newly developed DBR Multi-Item Scales (DBR-MIS). Teachers identified students with behaviors interfering with their learning or the learning of others and implemented a Daily Report Card (DRC) intervention in the classroom settings for two months. The analyses were performed on 31 AB single case studies. Change metrics were calculated at an individual level by using Tau-U_{A vs. B + trend B} and Hedges' g and at a scale-level by using Mixed Effect Meta-Analysis, Hierarchical Linear Models (HLMs), and Between-Case Standardized Mean Difference (BC-SMD). HLMs were estimated considering both fixed and random effects of intervention and linear trend within the intervention phase. The results supported sensitivity to change for three DBR-MIS (i.e., Academic Engagement, Organizational Skills, and Disruptive Behavior), and the relative magnitudes were consistent across the metrics. Sensitivity to change of DBR-MIS Interpersonal Skills received moderate support. Conversely, empirical evidence was not provided for sensitivity to change of DBR-MIS Oppositional Behavior. Particular emphasis was placed on the intervention trend in that responses to behavioral interventions might occur gradually or require consistency over time in order to be observed by raters. Implications for the use of the new DBR-MIS in the context of progress monitoring of social-emotional behaviors are discussed.     

On the longevity of behavioral interventions for challenging behavior

The capacity for a treatment to maintain its effects over time may be the most critical component of behavioral interventions for challenging behavior as treatments that fail to persist are likely to be of little value to society. We reviewed the quality and quantity of different types of post-intervention data for the treatment of challenging behavior in studies published over the last 7 years. We found that for the majority of participants at least one measure of maintenance, fading, or follow-up was reported but with limited information regarding the quality of those measures. Reports of secondary variables related to post-intervention data (e.g., latency to measurement) were also uncommon. We discuss possible explanations for the paucity of post-intervention data, barriers to obtaining post-intervention data, strategies for obtaining these data, and implications for the external validity of behavioral interventions for challenging behavior. We provide recommendations for increasing the probability that post-intervention data are included in applied research on challenging behavior.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.