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.     

Noncompliance in hemodialysis patients as measured with the MBHI

Abstract

Fifteen patients beginning maintenance hemodialysis due to renal failure were administered the Millon Behavioral Health Inventory, the Family Environment Scale and Beck Depression Inventory at the outset of treatment. They were then followed regarding their compliance with fluid, diet and medication, using weight change and serum potassium and phosphorus levels. Statistically significant differences were found on independence/dependence conflicts and between patients showing at least moderate noncompliance with weight and/or phosphorus limitations. Significantly higher levels of depression were associated with consistently poorer compliance patterns.     

DEFINING CHILD NONCOMPLIANCE: AN EXAMINATION OF TEMPORAL PARAMETERS

This study examined compliance parameters for 53 clinic-referred and nonreferred children, ages 2 to 10 years. Although there were significant differences between the referred and nonreferred samples for percentage compliance, there were no significant differences between the referred and nonreferred samples in terms of initiation or completion latencies. The average initiation latency was 5.92 s, whereas 98% of the sample initiated compliance within 14 s. Younger children did take longer to complete tasks. Results suggest that the use of short latencies in defining noncompliance may represent overly conservative criteria.     

Increasing compliance with medical examination requests directed to children with autism: effects of a high-probability request procedure

The purpose of this study was to evaluate the effectiveness of a high-probability (high-p) request sequence as a means of increasing compliance with medical examination tasks. Participants were children who had been diagnosed with autism and who exhibited noncompliance during general medical examinations. The inclusion of the high-p request sequence effectively increased compliance with medical examination tasks. In addition, the procedure was efficient, could be implemented by parents and medical professionals, and did not involve aversive procedures.     

BEHAVIORAL MOMENTUM IN THE TREATMENT OF NONCOMPLIANCE

Behavioral momentum refers to the tendency for behavior to persist following a change in environmental conditions. The greater the rate of reinforcement, the greater the behavioral momentum. The intervention for noncompliance consisted of issuing a sequence of commands with which the subject was very likely to comply (i.e., high-probability commands) immediately prior to issuing a low-probability command. In each of five experiments, the high-probability command sequence resulted in a “momentum” of compliant responding that persisted when a low-probability request was issued. Results showed the antecedent high-probability command sequence increased compliance and decreased compliance latency and task duration. “Momentum-like” effects were shown to be distinct from experimenter attention and to depend on the contiguity between the high-probability command sequence and the low-probability command.