DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

DENTIST-IMPLEMENTED CONTINGENT ESCAPE FOR MANAGEMENT OF DISRUPTIVE CHILD BEHAVIOR

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.     

MOMENTUM VERSUS EXTINCTION EFFECTS IN THE TREATMENT OF SELF-INJURIOUS ESCAPE BEHAVIOR

An individual's self-injurious escape behavior was treated using a high-probability instructional sequence with and without extinction. When presented alone, the high-probability sequence did not reduce self-injurious behavior. When escape extinction was implemented either alone or in combination with the high-probability sequence, self-injury decreased and compliance increased, suggesting that extinction may be a necessary component of the treatment for behavior problems maintained by escape.     

ESCAPE AS A FACTOR IN THE AGGRESSIVE BEHAVIOR OF TWO RETARDED CHILDREN

This study sought to identify some of the variables controlling the severely aggressive behavior of two retarded children. In Experiment 1, each child was presented with several demand and nondemand situations. Aggression was frequent in the demand situations and rare in the nondemand situations. When a stimulus correlated with the termination of demands was introduced, aggression fell to a near zero level. In Experiment 2, for one child, a variety of preferred reinforcers was introduced into the demand situation contingent on correct responding. Aggression abruptly decreased to a low level. Experiments 3 and 4 involved the second child. In Experiment 3, this child was permitted, in one condition, to leave the demand situation if he emitted a nonaggressive response. Aggression decreased to a low level. In Experiment 4, he was prevented, in one condition, from leaving the demand situation in spite of high levels of aggression. Aggression fell to a near zero level. In Experiments 3 and 4, he was permitted, in several conditions, to leave the demand situation following aggressive behavior. Aggression increased to a high level. The results suggested that: (1) aggression can sometimes function as an escape response; and (2) escape-motivated aggression can be controlled by: (a) introducing strongly preferred reinforcers to attenuate the aversiveness of the demand situation; (b) strengthening an alternative, nonaggressive escape response; or (c) using an escape-extinction procedure.     

THE USE OF POSITIVE AND NEGATIVE REINFORCEMENT IN THE TREATMENT OF ESCAPE-MAINTAINED DESTRUCTIVE BEHAVIOR

We identified 3 clients whose destructive behavior was sensitive to negative reinforcement (break from tasks) and positive reinforcement (access to tangible items, attention, or both). In an instructional context, we then evaluated the effects of reinforcing compliance with one, two, or all of these consequences (a break, tangible items, attention) when destructive behavior produced a break and when it did not (escape extinction). For 2 clients, destructive behavior decreased and compliance increased when compliance produced access to tangible items, even though destructive behavior resulted in a break. For 1 client, extinction was necessary to reduce destructive behavior and to increase compliance. Subsequently, when the schedule of reinforcement for compliance was faded for all clients, destructive behavior was lower and fading proceeded more rapidly when compliance produced multiple functional reinforcers (i.e., a break plus tangible items or attention) and destructive behavior was on extinction. The results are discussed in terms of the effects of relative reinforcement value and extinction on concurrent operants.     

VISITING THE DENTIST: A BEHAVIORAL COMMUNITY ANALYSIS OF PARTICIPATION IN A DENTAL HEALTH SCREENING AND REFERRAL PROGRAM

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a prerecorded message of “stop”). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.     

BEHAVIORAL PERSISTENCE AND VARIABILITY DURING EXTINCTION OF SELF-INJURY MAINTAINED BY ESCAPE

The self-injurious escape behavior of a developmentally disabled adult was treated with extinction. Results of a reversal design showed substantial bursts of responding when extinction was introduced and reintroduced: self-injury remained at a variable and elevated rate for some time before stable, low rates were observed. Data on aggression, a nontarget behavior during both baseline and treatment, showed a pattern similar to that seen for self-injury during the extinction conditions.     

THE RELATIVE MOTIVATIONAL PROPERTIES OF SENSORY AND EDIBLE REINFORCERS IN TEACHING AUTISTIC CHILDREN

We compared the effects of sensory and edible reinforcers on resistance to satiation in three autistic children while learning visual discrimination tasks. Within-subject designs were used to compare a single sensory reinforcer with a single edible reinforcer and to compare multiple sensory reinforcers with multiple edibles. Results indicated that multiple sensory reinforcers maintained responding over more trials than did multiple edible reinforcers; however, the use of single sensory reinforcers and single edibles resulted in about equal numbers of trials to satiation. Both multiple and single sensory reinforcers produced higher percentages of correct responses than edible reinforcers. The findings are discussed in terms of the advantages of sensory reinforcers in teaching autistic children.     

REEMERGENCE AND EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR DURING STIMULUS (INSTRUCTIONAL) FADING

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.     

THE USE OF NONCONTINGENT ESCAPE TO REDUCE DISRUPTIVE BEHAVIORS IN CHILDREN WITH SPEECH DELAYS

Noncontingent escape (NCE) was used to reduce disruptive behavior in 3 children during regularly scheduled speech therapy sessions. Results showed rapid decreases in disruptive behavior and accompanying increases in compliance across children. Findings suggest that speech therapists with little expertise in behavior analysis can effectively implement NCE.     

TOKEN REINFORCEMENT DURING THE INSTATEMENT AND SHAPING OF FLUENCY IN THE TREATMENT OF STUTTERING

The value of token reinforcement in the instatement and shaping of fluency was examined in an intensive treatment program for adult stutterers. Experiment 1 examined the effect of removing the tangible back-up reinforcers for the token system and found that clients' performance in the program was equally good with or without these back-up reinforcers, suggesting that a strict token economy may not be crucial to rapid progress through treatment. Experiment 2 compared contingent and noncontingent token reinforcement, while controlling for some variables that may have confounded the results of earlier research, and found no difference in clients' performance. Experiment 3 examined the effect of the entire removal of token reinforcement. Performance was found to be no worse under a “no tokens” system than under a system of tokens with back-up reinforcers. It is argued that in a highly structured treatment program where many other reinforcers are operating, token reinforcement may be largely redundant. Clinical and theoretical implications of the findings are discussed.     

EFFECTS OF DIRECT,INTERMITTENT, AND VICARIOUS REINFORCEMENT PROCEDURES ON THE DEVELOPMENT AND MAINTENANCE OF INSTRUCTION-FOLLOWING BEHAVIORS IN A GROUP OF YOUNG CHILDREN1

A group of young children (mean age: 2.5 yr) were instructed to follow different requests by a teacher in a day-care setting. Experiment I verified that mean group instruction following was low (10%) despite the opportunity for “observational learning”, i.e., the group of 12 children could watch a nonreinforced adult comply with the teacher's request. In Experiment II, when positive consequences were provided contingent on the adult model's behavior, mean group instruction following was relatively unaffected (14%). When direct reinforcement was given to four peer models, each for several sessions, the individual performances of three of the four peer models was elevated (from 50% to 80%); however, the mean performance of the remaining nonreinforced children (N = 7) was only moderately affected (21%). When reinforcement contingencies were again changed, so that each group member was provided direct, but intermittent reinforcement, mean group performance increased substantially to levels of over 70%. Once instruction following was high, presentation of reinforcement only to one peer model sufficed to maintain performance whereas earlier, this same vicarious reinforcement procedure had failed to establish group compliance. The maintenance of instruction-following behavior when reinforcement was applied solely to one child was interpreted mainly in terms of a high resistance to extinction following a history of intermittent reinforcement rather than a “vicarious”- or “self”-reinforcement mechanism. Finally, removal and re-introduction of group intermittent reinforcement, respectively, lowered performance (to levels of 40%) and elevated (to levels of 65%) the group's performance.     

PLAY VERSUS ALONE CONDITIONS AS CONTROLS DURING FUNCTIONAL ANALYSES OF SELF-INJURIOUS ESCAPE BEHAVIOR

We compared the effects of continuous reinforcement (play) and alone conditions as controls during functional analyses for 66 individuals whose self-injurious behavior (SIB) was maintained by escape. In every case, SIB was lower during both control conditions than it was during the test (demand) condition. However, SIB was lowest during the alone condition more often than it was during the play condition. Circumstances under which the alone condition might serve as an alternative or more suitable control for escape-maintained problem behaviors are discussed.     

THE GOOD TOOTHBRUSHING GAME: A SCHOOL-BASED DENTAL HYGIENE PROGRAM FOR INCREASING THE TOOTHBRUSHING EFFECTIVENESS OF CHILDREN

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the “Good Toothbrushing Game.” Each day four children from each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design (Hersen & Barlow, 1976, pp. 228–229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. The treatment terminal level for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0, and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.     

USE OF TEXTURE FADING IN THE TREATMENT OF FOOD SELECTIVITY

Children with feeding disorders often display severe food selectivity. For many of these children, consuming highly textured foods may be aversive or potentially dangerous because of frequent gagging. The purpose of this study was to demonstrate the efficacy of texture fading in the treatment of food selectivity displayed by 4 children. Treatment involved the gradual addition of higher textures based on the results of periodic probes. In addition, food acceptance and swallowing were reinforced, while food refusal and food expulsion were placed on extinction. Results showed that all participants successfully advanced to consumption of age-appropriate texture and volume. The results suggest that texture fading with intermittent probes at higher textures may be an effective method for the treatment of food selectivity by texture.     

TRAINING AND GENERALIZATION OF REACH-GRASP BEHAVIOR IN BLIND,RETARDED YOUNG CHILDREN

The effects of a graduated prompting treatment procedure were analyzed in three phases of an experiment on the training and generalization of reaching-grasp responding in 2- to 4-year-old blind, severely or profoundly retarded children. In Phase 1, we used a multiple-baseline across-subjects design to investigate the effectiveness of the treatment on midline reach-grasp responding. In Phase 2, we used a reversal design to investigate the effects of repeated implementations and withdrawals of the treatment. In both phases, generalization to right and left positions was measured. In Phase 3, in a multiple-baseline across-responses design, the treatment was implemented in right and left positions. Also in Phase 3, shift of stimulus control from toy-sound to verbal instructions was measured. The results showed that (a) the graduated prompting procedure was effective in training reach-grasp responding in all three children; (b) for one child, the effects were durable over repeated applications of the treatment procedure, but were not maintained during withdrawals; (c) for another child, the treatment procedure was effective in teaching reach-grasp responding in all three positions; and (d) for the same child, training of reach-grasp responding generalized to toys presented without sound, given only the verbal instruction.     

ASSESSMENT AND TREATMENT OF CLINICAL FEARS IN MENTALLY RETARDED CHILDREN

Three moderately mentally retarded females ranging from 8 to 10 years of age were treated for long-standing fears. These children had refused to talk with or be in the same general vicinity of adults other than their parents, a few close family members, and to a lesser degree, their teacher. To establish an accurate criterion for successful performance on dependent measures, participants were matched on age, sex, and level of mental retardation with children having “normal” amounts of fear. Dependent measures included approaching and talking to strange adults as well as child ratings of overall fear. Participant modeling was given by the mother who provided a sufficient amount of physical and verbal prompts to ensure that an acceptable greeting of adults specified by the mother were made. These prompts were gradually faded out as treatment progressed. Treatment, which was given in a multiple baseline format across subjects, proved effective and gains in the reduction of fears were maintained at the six month follow-up.     

幼儿记忆回涨实验研究

以哈尔滨师范大学幼儿园全体幼儿为对象（未经筛选）,采用录音机播放识记材料的方法,对幼儿记忆回涨现象进行了研究。结果发现：幼儿确实存在着不同于艾宾洁斯遗忘曲线的记忆回涨现象,而且年龄不同记忆回涨高峰时间亦不相同;复习与回涨高峰的关系实验结果发现,幼儿记忆回涨高峰期间复习效果最好。