Brief Behavioral Intervention for Young Children with Disruptive Behaviors

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2–6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.     

Combining psychodynamic and behavioral treatment approaches in the treatment of hospitalized adolescents

This article describes a treatment approach for hospitalized adolescents which attempts to address the "response generalization" problem encountered with behaviorally based treatment milieus. The program is described and preliminary data is given to support its techniques. The treatment program attempts to combine behavioral/objective techniques that are so effective in program management, with subjective/clinical strategies.     

Developmentally Sensitive Cognitive Behavioral Therapy for Adolescent School Refusal: Rationale and Case Illustration

School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent’s school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent–adolescent conflict). Two treatment-related consultations were also conducted with Allison’s homeroom teacher. Allison’s school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents’ use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.     

Preliminary Evaluation of Sleepwise Program for Children With Sleep Disturbance and Developmental Delay

Sleep disturbances are very prevalent in children with developmental delay. Parental-assisted behavioral strategies have been used effectively in school-aged children; however, multimodal treatment for preschool-aged children is lacking. The current study is a preliminary investigation of the effectiveness of a parent group program called Sleepwise designed for young children with developmental delay and incorporating behavioral, communicative, and sensory strategies. Six parents attended three workshop sessions and implemented individualized treatment plans. Initial results revealed significant posttreatment reductions in child sleep disturbances and behavioral problems, with high treatment acceptability ratings by parents. Outcomes were generally maintained at 1-month follow-up.     

Skills training in the long-term management of stress and occupational burnout

The current managed healthcare environment stresses brief and effective short-term therapy. However, often this short-term treatment does not lead to long-term behavioral changes and clients return to therapy many times for help with the same dysfunctional behavioral patterns. The main problem with these traditional forms of treatment is the assumption that clients have the basic skills to change their ineffective behaviors. Yet, many people lack the basic skills to manage our highly stressful society, and may take years to master new behavioral management skills. Examining the relationship between stress and coping, this study explored both short-and long-term approaches to behavioral change relative to occupational burnout, and focused upon the teaching of skills to manage stress. Subjects who participated in a 6-week stressmanagement program reported only temporary decreases in burnout, while those subjects who received 1-hour coping “refresher” sessions at 5 months, 11 months, and 17 months showed consistent decreases in burnout throughout a 2 1/2 year period. These results suggest that psychologists can be much more effective behavioral change agents through long-term approaches that emphasize teaching new skills to manage chronic behavioral problems. Given the changes in the health insurance industry and the way therapeutic services are provided, the field may need to rethink approaches that are grounded in personality theory and abnormal psychology to approaches that emphasize principles of learning theory.     

Skills training in the long-term management of stress and occupational burnout

The current managed healthcare environment stresses brief and effective short-term therapy. However, often this short-term treatment does not lead to long-term behavioral changes and clients return to therapy many times for help with the same dysfunctional behavioral patterns. The main problem with these traditional forms of treatment is the assumption that clients have the basic skills to change their ineffective behaviors. Yet, many people lack the basic skills to manage our highly stressful society, and may take years to master new behavioral management skills. Examining the relationship between stress and coping, this study explored both short-and long-term approaches to behavioral change relative to occupational burnout, and focused upon the teaching of skills to manage stress. Subjects who participated in a 6-week stressmanagement program reported only temporary decreases in burnout, while those subjects who received 1-hour coping “refresher” sessions at 5 months, 11 months, and 17 months showed consistent decreases in burnout throughout a 2 1/2 year period. These results suggest that psychologists can be much more effective behavioral change agents through long-term approaches that emphasize teaching new skills to manage chronic behavioral problems. Given the changes in the health insurance industry and the way therapeutic services are provided, the field may need to rethink approaches that are grounded in personality theory and abnormal psychology to approaches that emphasize principles of learning theory.     

Paradoxical intention in the treatment of urinary retention

Although most cases of psychogenic urinary retention can be ameliorated by a program composed of various behavioral techniques, there is a small percentage of cases which resists the behavioral treatment of choice. The present multiple case paper focused on the treatment of several resistant cases of functional urinary retention. Following a two week baseline period, each individual was exposed to eight weekly behavioral sessions. Whereas most cases of urinary retention have significantly improved by this time, the five individuals chosen for the present study were dissatisfied with their progress. Thus, following the eighth week, paradoxical intention was employed. Within six weeks treatment for the urinary problem was terminated as all clients were comfortable with this aspect of their daily behavior. It was hypothesized that cases of psychogenic urinary retention which resist behavioral techniques are possibly exacerbated by performance anxiety. Such anxiety can be efficiently handled by paradoxical intention.     

Sensory Processing Difficulties, Behavioral Problems, and Parental Stress in a Clinical Population of Young Children

This study examined the relationship between sensory processing difficulties, parental stress, and behavioral problems in a clinical sample of young children with developmental and behavioral difficulties. We hypothesized that a high rate of sensory processing difficulties would be found, that there would be a high rate of comorbidity between sensory processing difficulties and behavioral problems, and that children’s sensory processing difficulties and parental stress would be highly correlated. Parents of 59 children ages two to five who attended an out-patient clinic in a low income, urban community completed the Child Behavior Checklist, Parental Stress Inventory-Short Form and the Short Sensory Profile. Children in this clinical population showed a high prevalence (55.9 %) of sensory processing difficulties, a significantly higher rate than previously reported. Sensory processing deficits were correlated with behavioral difficulties and parental stress levels-suggesting that as sensory processing difficulties increase, so do behavioral difficulties and parental stress. Parents of children with sensory processing deficits had significantly higher levels of parental stress than parents of children without sensory deficits. Parenting stress levels were also clinically elevated for the cohort of children in which sensory processing difficulties and behavioral concerns co-existed. These findings suggest that treatment outcomes might improve and parental stress could be reduced if mental health clinicians were trained to identify and address sensory problems. This could result in more children being screened and treated for sensory processing difficulties and an eventual reduction in the rates of parental stress.     

A supplementary behavioral program to improve deficient reading performance

A behavioral program was designed to deal with certain skill and attentional problems of a group of below-grade-level readers. Fourteen 7–12-year-old problem readers were already enrolled in an on-campus behavioral tutoring program. From This group, seven Ss (experimental group) were placed into the supplementary program, which basically consisted of a point system to reward attention to and identification of letter and word combinations. The remaining seven problem readers (yoked-control group) were given the same materials but without a specific task or reinforcement. After seven to ten 30-minute sessions over a 7-week period, the experimental group had improved significantly more than had the control group, based on a comparison of standardized reading test scores.This study was supported by grant OEG-2-2-2 BO24 from the National Institute of Education.Valuable assistance was provided by Sandra Armel, Steve Rayack, Betty White, and Al Castaldi, of the State University of New York at Stony Brook.     

Effects of Maternal Depression Symptoms and Alcohol Use Problems on Child Internalizing and Externalizing Behavior Problems

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.     

Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

A comparative outcome study of behavioral social-skills training, interpersonal-problem-solving and non-directive control treatments with child psychiatric outpatients

The purpose of the present study was to compare the short- and long-term efficacy of behavioral social-skills training and interpersonal-problem-solving with a control condition (non-directive treatment) with a clinical population of 61 socially-maladjusted outpatient boys. Treatment consisted of 12 weekly 1-hr sessions, with follow-up conducted at 12 months. A comprehensive assessment strategy was employed which included direct behavioral observations, parent, teacher, peer, self-report and academic performance measures. The results of this social-skills comparative outcome study indicated that the behavioral and interpersonal treatments resulted in changes on parent, teacher, self-report and peer sociometric ratings at post-treatment. At the 1-yr follow-up, the behavioral treatment maintained it's gains and continued to show modest improvement. Conversely, the interpersonal treatment manifested significant declines, as did the control group. These findings and implications for future research are discussed.     

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

Many institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated-teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.     

Resolving Problems of Mainstreaming:

Evaluation results are reported about a program designed to train educational administrators in interpersonal problem solving with staff relative to problems of educating mainstreamed handicapped students. Results are reported for two instances of implmentation of this training program: an initial implementation and a replication condition. In each instance, four public high school principals were provided interpersonal problem solving training by means of three, four-hour sessions. Training involved use of behavioral specification of the interpersonal problem solving skills to be acquired, didactic persentations, role play exercises, performance feedback, and social reinforcement. Following both instances of program implementation, increases in interpersonal problem solving skills were observed for all administrators (trainees) in simulation and naturalistic settings. Ratings of videotapes of the trainees made by other high school principals who were unaware of the program indicated that quality of interpersonal probelm solving performance of trainees was greater following training than before training. Also, these raters indicated that the training program would be benefical to themselves and colleagues.     

Increasing Anger Log Use During School Among Middle School Students with Emotional/Behavioral Disorders

ABSTRACT

Although anger management programs often promote the use of anger logs as an alternative to aggressive behavior, researchers have not studied whether or not these programs actually increase anger log use. Thus, this study examines the impact of In Control, a classroom-based curriculum with 10 weekly 30-minute sessions, on the frequency of anger log use between sessions. Study participants were all of the students attending a middle school for emotional/behavioral disorders. Twenty-seven students received the In Control program, and 19 equivalent students did not. While anger logs were visibly available in all of the classrooms, the students who received the In Control program completed significantly more logs between sessions than did the nonprogram students. During a 4-month follow-up, the 19 program students who received monthly booster sessions continued to fill out significantly more logs than did the nonprogram students. These findings suggest that In Control can increase the use of a log to record anger-provoking episodes by middle school students with serious emotional/behavioral disorders, both in between training sessions and during follow-up, if booster sessions are provided.     

Selection of Public Housing Tenants: On the Feasibility of Using an Objective Screening Procedure1

Problems facing public housing authorities can be addressed through two basic alternative perspectives. One assumes that difficulties result from the behavior of certain “problem” tenants and recommends careful screening of applicants. This perspective influenced a housing authority in a small city, which desired a means to select tenants who would be less likely to exhibit problems. Information in the records of the housing authority was analyzed to identify tenant characteristics predictive of problem tenancy. The findings indicated that these problems were not as widespread as believed by management and that tenant characteristics were not strongly predictive of problems. Application of this approach would probably not constitute a significant improvement over present practices and might allow unfair discrimination to occur unwittingly. Instead, the most feasible strategy to reduce the impact of problem tenancy, even within a single locale, seems to be to focus on management practices and to address the more fundamental causes of tenant difficulties.     

Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Prise en charge des troubles du comportement du jeune enfant par le programme Parent-Child Interaction Therapy (PCIT)

Behavioral disorders in preschool children have negative repercussions for families and children. Across the Atlantic, many Parent Management Training (PMT) programs have emerged over the last 40 years. These are evidence-based interventions, recommended for the management of children's behavioral disorders. Literature findings Parent-Child Interaction Therapy (PCIT), recently translated into French, is a PMT providing in-vivo coaching, based on attachment and behavioral theories. PCIT is structured into two distinct intervention phases: the child-directed interaction, and the parent-directed interaction. Each phase begins with a parental skill teach session, followed by in vivo coaching sessions, where parent and child dyads together. It is a brief therapy (14 sessions on average), individualized, and adapted to families' difficulties. Numerous studies and meta-analyses highlight high effect sizes, equal to or greater than existing PMT. Discussion Although PMT is a best-practice treatment for behavioral disorders, and although attrition rates are low compared to other forms of child psychotherapy, treatment retention remains a concern. Promising adaptations of PCIT are now also being studied: in-home, intensive, short format or remotely. Conclusion PCIT can therefore allow many professionals to develop a stronger repertoire of effective treatment for childhood behavior disorders.     

Eliminating the battering of women by men: Some considerations for behavior analysis

Based on review of representative literature, history and current research indicate that battering by male partners is a major health problem for women. Use of physical aggression and verbal coercion can be described by three-term contingencies involving escape, avoidance, punishment, and positive reinforcement. These contingencies occur within societal practices, rules, and models that involve oppression of women and insubstantial consequences for men who batter. The difficulties in directly observing a couple's interactions and their aggression have been a methodological barrier to the involvement of behavior analysts in treatment of and research on domestic violence. Recommendations are made for behavior analysts to contribute to reducing battering through development and analysis of program components and application of contingency management and behavioral training technology.     

Development and description of an empirically based ecobehavioral treatment program for child maltreatment

Victims of child maltreatment and their families evince a myriad of behavioral problems, including deficits in parenting skills, social skills, safety skills, anger, stress, and financial management, mood disorders, and abusive behavior. Controlled treatment outcome studies in child maltreated samples have indicated that many of these problems are responsive to clinical intervention strategies. However, empirically based practitioners who treat child maltreatment are faced with the inevitable task of effectively integrating these treatments into their clinical programs. Therefore, this paper describes the development of an ecobehavioral treatment program for child maltreatment that is founded on a comprehensive integration of previously validated procedures. The program's development, and methods of assessment and intervention, will be underscored, including therapist training strategies, and solutions to problems that sometimes occur. Data in support of the program is examined, but primarily as a means to demonstrate how evaluative components may be utilized in practice settings to guide intervention. Copyright © 1999 John Wiley & Sons, Ltd.