Early Temperament and Attachment Security with Mothers and Fathers as Predictors of Toddler Compliance and Noncompliance

This longitudinal study (n = 106) examined associations between temperament, attachment, and styles of compliance and noncompliance. Infant negative temperamental reactivity was reported by mothers at 3, 5 and 7 months. Infant attachment was assessed (Strange Situation) at 12 (mothers) and 14 months (fathers). Toddlers' styles of compliance/noncompliance were measured using two laboratory contexts (clean‐up/delay) at 20 months. Results indicated that temperament and attachment predicted toddler behaviour. Toddlers who were secure with mothers and low in temperamental negative reactivity showed more committed compliance than those who were insecure and low in negative reactivity or secure and high in negative reactivity. In addition, interactions revealed that relations between infant–mother attachment and defiance depended on infant–father attachment security, temperament and context. Findings highlight the differential and complex roles of temperament and attachment as potential precursors of later social competence. Copyright © 2013 John Wiley & Sons, Ltd.     

Refraining Resistance and Noncompliance in Cognitive Therapy

Despite its general success, not everyone responds to cognitive therapy. Some clients have difficulty complying with assignments and others appear to be frankly resistant. This article considers strategies for dealing with passive noncompliance and active resistance within cognitive therapy. In general, it is argued that the process of therapy is usually facilitated by staying within the cognitive model—that is, by exploring and working through those beliefs and attitudes that underlie noncompliance and resistance in the same manner that other problematic beliefs and attitudes are approached. Also considered are strategies for dealing with unrealistic expectations regarding the pace of change, therapists' errors leading to noncompliance and resistance, and instances in which the therapeutic model is simply insufficient.     

Adjustment to hemodialysis treatment through behavioral controls

The present study was conducted to examine the hypothesis that compliant chronically ill patients, typically described as adjusted, reinforce more positive social environments using behavioral controls than noncompliant patients, typically described as maladjusted. Specifically, it is hypothesized that diet-compliant chronic hemodialysis patients emit significnatly more active involvement-in-treatment behaviors and more social behaviors than diet-noncompliant chronic hemodialysis patients. Subjects, who ranged in age from 30 to 77 years, were outpatients at a kidney center. Behavioral observations were conducted to assess the occurrence or frequency of (1) four involvement-in-treatment behaviors that are routinely taught to all patients and (2) two social behaviors, which were patient verbalizations and smiles. The results showed that compliant patients emitted significantly more involvement-in-treatment behaviors and smiles than noncompliant patients. Results support the proposed control framework that compliant, in contrast to non-compliant, chronically ill patients have recourse through positive behavioral controls when adjusting to the stresses of illness. It was proposed that through these controls, compliant patients reinforce positive environments rather than simply respond to life circumstances as given.     

Further analysis of modifications to the three-step guided compliance procedure to enhance compliance among children with autism

Three-step guided compliance (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) is a commonly used procedure to increase compliance among children with intellectual disabilities. Previous research has suggested that under some conditions, slight modifications to the three-step procedure may enhance its effectiveness. These modifications include omitting the model prompt and decreasing the interprompt interval. In the current study, we evaluated another modification to the procedure: the delivery of a high-preference item contingent upon compliance with the first vocal prompt (i.e., differential reinforcement). For 2 participants with autism, compliance remained low when we implemented differential reinforcement and the guided compliance procedure in isolation. However, compliance improved when we combined differential reinforcement and the three-step guided procedure, suggesting that for at least some children, the combination of contingent access to a high-preference item and the guided compliance procedure is more effective than either intervention alone.     

Assessing Parental Response Patterns in the Treatment of Noncompliance in Children

Child noncompliance is one of the most frequently reported behavior problems in clinic-referred children. One difficulty with treating noncompliance in the clinic is that the demand characteristics of the situation may alter the rates of child compliance. The observation of parent-child interactions, with an emphasis on parent behaviors, may be a more meaningful way to assess parent training programs. In the current study, the parents of three children each showed a distinctive pattern in their responding to their children's compliant and noncompliant behaviors. An in vivo direct instruction procedure, that involved the therapist working directly with the parent to provide immediate consequences was used. Following training, improvements in correct responding were evident for al parents. Particularly noteworthy was that child compliance was not an accurate indicator when assessing parents' initial skill levels.     

An analysis of modifications to the three-step guided compliance procedure necessary to achieve compliance among preschool children

After a 3‐step guided compliance procedure (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) did not increase compliance, we evaluated 2 modifications with 4 preschool children who exhibited noncompliance. The first modification consisted of omission of the model prompt, and the second modification consisted of omitting the model prompt and decreasing the interprompt interval from 10 s to 5 s. Each of the modifications effectively increased compliance for 1 participant. For the remaining 2 participants, neither modification was effective; differential reinforcement in the form of contingent access to a preferred edible item was necessary to increase compliance. Problem behavior varied across participants, but was generally higher during guided compliance conditions and lower during differential reinforcement conditions.     

The Failure to Contain: How Persecutory Anxieties Contribute to Noncompliance in Adult Patients with Congenital Chronic Pain Conditions

ABSTRACT

Patients with sickle-cell disease suffer from lifelong pain. Many prefer to receive emergent rather than managed health care, which results in these people being termed “noncompliant.” This paper explores the contributing factors of such noncompliance in the adult patient with painful chronic illness. In the earliest stages of development, internal pain is attributed to external origins, and the effects of this on the psyche are analogous to those of physical abuse. When the infant's pain cannot be contained, projective identification and persecutory anxieties become deeply ingrained. Interventions that focus on healing from trauma and building trust are preferable to those which most value immediate compliance, as the patterns of behavior are so firmly entrenched.     

The distribution of repressive coping styles among non-metastatic and metastatic breast cancer patients as compared to non-cancer patients

Abstract

Recent investigations have shown increased disease progression among breast cancer patients with a “repressive” coping style characterized as: passive, conforming, inclined to deny physical symptoms and emotionally unexpressive. The Millon Behavioral Health Inventory (MBHI) scales which delineate three discrete repressive coping styles include the: Introversive, Cooperative and Respectful. Forty-four women recently diagnosed (within four weeks) with non-metastatic (N=32) or metastatic (N=12) breast carcinoma, responded to the MBHI upon admission for treatment of their disease at a cancer treatment unit. All subjects received mastectomy as well as chemotherapy, radiation and/or endocrine therapy. These 44 Cancer patients were compared to 34 control subjects, comprising women who were seen at a colposcopy clinic for follow-up of a suspicious pap smear which was ultimately shown to be benign or consisted of mild dysplasia. Non-metastatic, metastatic and control subjects were compared with respect to coping style and psychological distress. The breast cancer patients were more likely to employ a repressive coping style as compared to non-cancer patients who utilized a “sensitizing” coping strategy predominantly. Cancer patients with the most severe prognosis (metastasis) were the only group within the study to attain a clinically significant mean base rate score on the respectful scale. Results suggest that the incidence of repressive coping styles may be disproportionately high among breast cancer patients.     

Noncompliance in end-stage renal disease: A threat to quality of care and cost containment

Noncompliance to treatment regimen after kidney transplantation is a threat to health outcomes and cost containment. Although there are methodological challenges to obtaining reliable compliance data, the results of noncompliance are increased morbidity and mortality in posttransplant patients. In addition, recent research suggests that patients who incur repeated rejection episodes leading to graft failure have higher levels of medical utilization. Some psychosocial factors related to compliance and medical utilization are potentially modifiable through cognitive-behavioral intervention.     

An analysis of stimuli that influence compliance during the high-probability instruction sequence

When we evaluated variables that influence the effectiveness of the high-probability (high-p) instruction sequence, the sequence was associated with a precipitous decrease in compliance with high-p instructions for 1 participant, thereby precluding continued use of the sequence. We investigated the reasons for this decrease. Stimuli associated with the low-p instruction were systematically added and removed in the context of the high-p instructions, and results suggest that the stimuli associated with the low-p instruction influenced compliance with the high-p instructions.     

A method to establish stimulus control and compliance with instructions

We evaluated a unique procedure to establish compliance with instructions in four young children diagnosed with autism spectrum disorder (ASD) who had low levels of compliance. Our procedure included methods to establish a novel therapist as a source of positive reinforcement, reliably evoke orienting responses to the therapist, increase the number of exposures to instruction–compliance–reinforcer contingencies, and minimize the number of exposures to instruction–noncompliance–no reinforcer contingencies. We further alternated between instructions with a high probability of compliance (high‐p instructions) with instructions that had a prior low probability of compliance (low‐p instructions) as soon as low‐p instructions lost stimulus control. The intervention is discussed in relation to the conditions necessary for the development of stimulus control and as an example of a variation of translational research.     

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as mild (adjustment reaction only) or severe (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of clinically significant elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.     

Further evaluation of antecedent interventions on compliance: the effects of rationales to increase compliance among preschoolers

Functional analyses were conducted to identify reinforcers for noncompliance exhibited by 6 young children. Next, the effects of rationales (statements that describe why a child should comply with a caregiver-delivered instruction) were evaluated. In Experiment 1, 3 participants received the rationales immediately after the therapist's instruction. In Experiment 2, 3 additional participants received more practical rationales immediately before the therapist's instruction. The results indicate that rationales were ineffective for all 6 children. A guided compliance procedure increased compliance for 1 child; contingent access to preferred items with or without response cost increased compliance for the other participants. Although levels of problem behavior varied within and across participants, they were often higher in the rationale and guided compliance conditions.     

EFFECTS OF REINFORCER QUALITY ON BEHAVIORAL MOMENTUM: COORDINATED APPLIED AND BASIC RESEARCH

The high-probability (high-p) instructional sequence has been an effective treatment for noncompliance. However, treatment failures have also been reported. We hypothesized that the efficacy of the high-p treatment may be improved by using higher quality reinforcers for compliance to high-p instructions. The resistance of compliance to change was tested by varying reinforcer quality in two applied studies and a basic laboratory experiment. Experiment 1 tested the hypothesis that an increase in reinforcer quality for high-p compliance will increase the effectiveness of the high-p treatment when it fails to increase compliance. Experiment 2 assessed the effects of reinforcer quality on resistance of compliance to change by presenting successive low-p requests following the high-p treatment. A basic laboratory study (Experiment 3) was conducted to further isolate the relation between reinforcer quality and behavioral momentum. Two different liquid reinforcers (sucrose and citric acid solutions) were presented in a two-component multiple variable-interval variable-interval schedule followed by a single extinction test session. Results of all three experiments showed a generally consistent relationship between reinforcer quality and behavioral momentum.     

Predicting behavioral outcomes with two psychological assessment methods in an outpatient pain management program

Abstract

In research with pain patients, the determination of psychological variables that can predict physiological gains would be helpful for practitioners doing assessments on pain patients. The present study used the Millon Behavioral Health Inventory (MBHI) and the Minnesota Multiphasic Personality Inventory (MMPI) to assess whether gains in time sitting, time standing, number of stairs climbed, time on a treadmill, treadmill speed, grip strength in both hands, and a composite score of these variables could be successfully predicted for patients at a 20-day outpatient multidisciplinary pain rehabilitation program. Discriminant analyses demonstrated that both the MBHI and the MMPI were successful in this prediction. Advantages for using the two instruments singly and together in assessment procedures and suggestions for future research are made.     

The effects of varying levels of treatment integrity on child compliance during treatment with a three-step prompting procedure

The effects of three levels of treatment integrity (100%, 50%, and 0%) on child compliance were evaluated in the context of the implementation of a three-step prompting procedure. Two typically developing preschool children participated in the study. After baseline data on compliance to one of three common demands were collected, a therapist implemented the three-step prompting procedure at three different integrity levels. One integrity level was associated with each demand. The effects of the integrity levels were examined using multielement designs. The results indicate that compliance varied according to the level of treatment integrity that was in place.     

Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis.

An 8-year-old boy with cystic fibrosis (CF), mental retardation, and autism exhibited noncompliance with respiratory treatments that were essential for the management of his CF. A treatment involving shaping cooperation while still allowing escape for aggression and avoidance behavior resulted in increases compliance with respiratory treatments and decreases in problem behavior. Treatment gains were maintained over 3 months.     

Self-appraised problem-solving skills and the prediction of secondary complications among persons with spinal cord injuries

Secondary complications following spinal cord injury (SCI) include decubitus ulcers and recurrent urinary tract infections. These conditions can significantly impair quality of life and prove life-threatening; it is also believed that these conditions are mediated by behavioral pathways. According to the social problem-solving model, persons who report effective problem-solving skills should be capable of adhering to long-term therapeutic regimens of self-care necessary to prevent these complications. We tested this assumption in the present study. Discriminant function analyses revealed self-appraised skills in approaching and defining problems contributed to the prediction of secondary complications among 53 persons with SCI. Results are discussed in light of the social problem-solving model, and the utility of problem-solving interventions in rehabilitation is explored.