SOLITARY TOY PLAY AND TIME OUT: A FAMILY TREATMENT PACKAGE FOR CHILDREN WITH AGGRESSIVE AND OPPOSITIONAL BEHAVIOR

The behavior of four boys, 5 to 8 years of age, who were referred for a number of oppositional, rule violating, and aggressive behaviors, was assessed by direct observation and parent reports. Following baseline measurement, several interventions were successively applied to each child's behavior. Use of a social play contract to reduce problem behaviors by teaching appropriate social behaviors resulted either in no improvement or in worsening of the problem behaviors in observations made when the contract was not in effect. Changing the contract behavior to solitary toy play resulted in reduced oppositional behavior during the observation sessions, fewer reports from the parents of low-rate problem behaviors, and improvements in the parents' attitudes toward the children. However, these changes during the observation sessions were shortlived, because the data on these measures began to show a reversal during later sessions. Inclusion of a time-out contingency with the solitary play contract recovered the earlier improvements in the children's behavior during observation sessions and the parents' reports. These results gave support to the view that for children whose behavior is severely oppositional and aggressive, a treatment approach emphasizing productive, solitary behaviors may be superior to one stressing appropriate social interaction. However, a combined strategy of reinforcement for solitary play and punishment for problem behaviors appears necessary to ensure more durable treatment effects.     

Effects of Cognitive Restructuring Intervention Program of Rational-Emotive Behavior Therapy on Adverse Childhood Stress in Nigeria

This study examined the effects of cognitive restructuring intervention program of rational-emotive behavior therapy on irrational thoughts/behaviors arising from adverse childhood stress in Nigeria. The participants (n = 26) are the identified victims of adverse childhood stress who met the criteria for inclusion through self-report questionnaire. The treatment process is guided by the adverse childhood stress management manual. It consists of 12 weeks of full intervention and 2 weeks of follow-up meetings. The study used repeated measures ANOVA in order to see the improvement of each participant and across control and treatment groups’ thoughts/behaviors after the intervention program. The results show that sex differences do not determine experience of adverse childhood stress. Through cognitive restructuring intervention program of rational-emotive behavior therapy, irrational thoughts/behaviors arising from adverse childhood stress experience were significantly reduced in the treatment group when compared to the control group. Significant improvement was also observed at the end of the intervention of the treatment group. The implication for research and practice were discussed in line with these outcomes. Finally, the study stressed the importance of a follow-up study in Nigeria that would assess irrational beliefs and one or more measures of PTSD symptoms or emotional disturbance.     

Training interpersonal skills among mentally retarded and socially dysfunctional children

Two moderately retarded boys, ages 11 and 12 yr, who resided in an inpatient unit for emotionally disturbed children, were treated for deficits in social skills. The deficits included physical gestures, facial mannerisms, eye contact, words spoken, and intonation and content of speech. The treatment package consisted of instructions, performance feedback, social reinforcement, modeling, and role-playing. The effects of the treatment in developing appropriate social performance were evaluated in separate multiple-baseline designs across behaviors for each child. The training improved social skills and brought children up to or beyond the level of normal control subjects who were the same age and gender.     

A comparative outcome study of four cognitive therapies in the treatment of social anxiety

This clinical outcome study compared four separate cognitive behavioral and one behavioral treatment for reducing social anxiety with a waiting list control. Subjects were adults who responded to advertisements for treatment. In the cognitive-behavioral conditions, subjects were trained to modify their disruptive cognitions and/or emit adaptive cognitions relevant to interpersonal behavior with the specific content and techniques determined by the particular cognitive therapy. In the behavioral condition, subjects modeled and rehearsed appropriate social interpersonal behaviors. Subjects were assessed pre and post-treatment on self-report measures of social anxiety, measures of general anxiety, clinical scales of anxiety, depression and hostility, and behavioral, and physiological concomitants of social anxiety. Subjects in all active treatment conditions showed improvement on the measures of social anxiety and the behavioral measure. However, only those in the cognitive treatment conditions, demonstrated treatment effects on general anxiety and the clinical scales. The results indicate the efficacy of both cognitive and behavioral approaches to the reduction of social anxiety. However, they fail to demonstrate clear distinctions between the various cognitive therapies.     

SOCIAL SKILLS TRAINING WITH CHILDREN: PROCEED WITH CAUTION

Three learning disabled children, selected on the basis of peer sociometric ratings and teacher referral, received social skills training. A group training procedure consisting of coaching, modeling, behavior rehearsal, and feedback was used to teach children the target behaviors of eye contact and appropriate verbal responses. A multiple baseline analysis across target behaviors was used to demonstrate treatment effectiveness on role-play scenes trained during treatment sessions. Duration of speech was measured as an untrained, corollary measure. The following measures were also obtained during baseline, posttreatment, and 1-mo follow-up for the experimental subjects and three control subjects: (a) performance on role-play scenes not trained during treatment sessions; (b) behavioral observations in a free play setting, and (c) sociometric ratings. In addition, the trained and untrained role-play scenes were administered by novel experimenters following treatment. The results indicated that socially unskilled, learning disabled children can be taught to respond appropriately to role-play situations. However, improved performance did not generalize to the natural school setting and treatment did not effect ratings of peer acceptance. The implications of these findings for future social skills training with children are discussed.     

EFFECTS OF SPACED RESPONDING DRL ON THE STEREOTYPED BEHAVIOR OF PROFOUNDLY RETARDED PERSONS

Stereotypic responding and social behaviors of three profoundly retarded children were measured before and during application of a DRL contingency for stereotypic responding. A variant of the standard DRL procedure, spaced responding DRL, was used, in which reinforcement is delivered following a response if that response has been separated from the previous response by at least a fixed minimum time interval. Three children were treated by using a reversal design. Results showed that: (a) during baseline sessions, the children engaged in high rates of stereotypic responding and very low rates of appropriate social behavior; and (b) during DRL sessions, appropriate behavior increased markedly as stereotypic responding was reduced. The data suggest that spaced responding DRL may be effective in increasing appropriate social behavior as well as in reducing stereotypic responding.     

An anger-control intervention with aggressive delinquent youths

Social problem-solving skills, a self-instructional procedure, and a “thinking-ahead” procedure were taught to institutionalized, aggressive, delinquent adolescents as part of an anger-control intervention package. A multiple baseline design across four subjects and an alternating-treatments design were used. The effects of intervention were assessed on problem-solving ability, use of self-guiding verbalizations for coping with anger provoking situations, reported frequency of anger-control behaviors relative to loss of anger-control incidents, and behavioral progress within the institution. All youths showed improvement during the training of problem solving on hypothetical dilemmas, with some generalization to untrained problems. Follow-up data on some youths suggested maintenance of treatment gains. Three of the youths displayed increased usage of self-instructions and thinking-ahead statements during personal anger-provoking situations. All youths displayed an increase in self-reported anger-control behaviors relative to loss of anger-control. Improvements in behavior outside of the therapy sessions were indicated by positive behavioral progress within the institution.     

TREATMENT OF SOCIAL BEHAVIOR IN AUTISM THROUGH THE MODIFICATION OF PIVOTAL SOCIAL SKILLS

We examined acquisition of individual social communicative behaviors and generalization across other social behaviors in 2 children with autism. The results of a multiple baseline design showed that the children's treated social behaviors improved rapidly and that there were generalized changes in untreated social behaviors. These improvements were accompanied by increases in subjective ratings of the overall appropriateness of the children's social interactions. The results suggest the possibility of identifying pivotal response classes of social communicative behavior that may facilitate the understanding of social behavior in autism as well as improve peer interactions, social integration, and social development.     

A comprehensive dining program for mentally retarded adults

Twenty-six types of behavior (e.g. uses fork in socially appropriate manner, chews food before swallowing) were treated in a course of independence training, using 80 institutionalized retarded adults (40 experimentals and 40 no-treatment controls). The 3-month long training phase incorporated a number of treatment components including in vivo modeling, peer social reinforcement, self-evaluation and monitoring; then a four-month follow-up. A group (i.e. experimentals and controls) by sex, by time, analysis of variance was computed with repeated measures on the last dimension (pre, post, follow-up measures = time). A significant difference was obtained between the experimentals and controls on post-test and follow-up     

EFFECTS OF A PROCEDURE DERIVED FROM THE OVERCORRECTION PRINCIPLE ON MANIPULATED AND NONMANIPULATED BEHAVIORS

Positive practice overcorrection has been shown to be effective in reducing stereotypic self-stimulatory behaviors displayed by retarded and autistic individuals. In addition, the procedure also may increase the occurrence of appropriate behavior through intensive practice. In the present study, several stereotypic and one appropriate behavior (appropriate toy play) displayed by two autistic children were measured before and during treatment by a positive practice in appropriate toy play overcorrection procedure. Overcorrection was introduced for each of the targeted inappropriate behaviors in succession for both children. Results showed that overcorrection reduced all stereotypic behaviors displayed by both children. In addition, one subject displayed marked increases in the behavior practised during overcorrection, appropriate toy play, relative to its baseline rate of occurrence. The results indicate that for some individuals, overcorrection may be effective in teaching and motivating appropriate forms of behavior as well as in reducing stereotypy.     

Conversation skills training for socially isolated children

A social skills training program consisting of instructions, modeling, behavior rehearsal, performance feedback, and programmed generalization set was used to teach conversational behavior to four socially isolated children. Effects of training were assessed in a multiple-baseline analysis across behavior. Subjects were selected on the basis of peer sociometric ratings, a behavioral role-playing task, naturalistic observation, and teacher ratings. All subjects demonstrated noticeable improvement in the target behavior as well as in overall conversational ability. However, these gains were maintained unequally in the children at follow-up probe administrations (4-and 8-weeks). Generalization assessment revealed some transfer of treatment effects to the school setting for all children. Results are discussed in terms of the complexity of social isolation in children and factors which influenced generalizability of the treatment program.     

Parent‐implemented behavioral skills training of social skills

Impairment in social skills is a primary feature of Autism Spectrum Disorders (ASDs). Research indicates that social skills are intimately tied to social development and negative social consequences can persist if specific social behaviors are not acquired. The present study evaluated the effects of behavioral skills training (BST) on teaching four parents of children with ASDs to be social skills trainers. A nonconcurrent multiple baseline design across parent–child dyads was employed and direct observation was used to assess parent and child behaviors Results demonstrated substantial improvement in social skills teaching for all participants for trained and untrained skills. Ancillary measures of child performance indicated improvement in skills as well. High levels of correct teaching responses were maintained at a 1 month follow‐up. This study extends current literature on BST while also providing a helpful, low‐effort strategy to modify how parents can work with their children to improve their social skills.     

Use of delayed feedback and reinforcement for reducing inappropriate behaviors with chronically institutionalized mental clients

This study investigated the efficacy of: (a) delayed feedback; (b) delayed feedback and social reinforcement; or (c) delayed feedback, social reinforcement, and tangible reinforcement for reducing the rate of bizarre motoric behaviors for 2 female and 1 male chronically institutionalized mental clients. These treatments were consecutively employed with each subject, utilizing a multiple baseline across subjects experimental design. Results indicated that these subjects were able to retain and understand the feedback on both their problem and alternative behaviors but that reductions in the inappropriate motoric behaviors resulted only when tangible reinforcers were included in the treatment. Implications for further investigations and for the utility and efficiency of delayed feedback and reinforcement with chronically institutionalized adults are discussed.     

APPLICATION OF A SOCIAL SKILLS TRAINING PROGRAM IN THE MODIFICATION OF INTERPERSONAL DEFICITS AMONG RETARDED ADULTS: A CLINICAL REPLICATION

Six mentally retarded adults, equally divided into two treatment groups, were provided with individualized social skills training programs. Treatment, evaluated via a multiple-baseline design strategy, was sequentially and cumulatively applied across target behaviors over a four-week intervention period. Behavioral observation probes and social validation measures served as the primary dependent variables. Results indicated that (a) treatment was effective for virtually all behaviors across all subjects, (b) improvements occurred for both training and generalization scenes, and (c) behavioral performance was maintained one month following the termination of treatment.     

TEACHING CHILDREN WITH AUTISM APPROPRIATE PLAY IN UNSUPERVISED ENVIRONMENTS USING A SELF-MANAGEMENT TREATMENT PACKAGE

The present study used a self-management treatment package to teach 3 children with autism, who exhibited inappropriate play behaviors, to play appropriately in the absence of a treatment provider. After self-management training, generalization and maintenance of the behavior change were assessed. Because of the detrimental effects of self-stimulation (arm flapping, spinning toys, twirling, etc.) on learning, the relationship between self-stimulatory behaviors and appropriate play was measured. Results indicated that the children learned to exhibit appropriate play skills in unsupervised settings, appropriate play skills generalized to new settings, and 2 of the children maintained their gains at 1-month follow-up. In addition, self-stimulatory behaviors decreased as appropriate play increased. Treatment implications of these findings are discussed.     

Use of a token economy to eliminate excessive inappropriate social behavior in an adult with developmental disabilities

Adults with developmental disabilities frequently have both deficits in appropriate social skills and excesses in inappropriate social behavior (Matson, LeBlanc, & Weinheimer, 1999). Typically, published treatment studies have focused on social skills training procedures that teach and promote the use of new social behaviors. However, only a few studies have focused on management of existing social behaviors that are problematic because they occur excessively or in an inappropriate context (Wright, Herzog, & Seymour, 1992). The current study focuses on management of three types of inappropriate social behavior in a 26‐year‐old male with moderate mental retardation: inappropriate social interactions, inappropriate sexual behavior, and verbal aggression. A token economy with response cost procedure was implemented using a DRO interval as the basis for earning tokens. Using a multiple‐baseline design across behaviors, each of the three types of inappropriate social behavior was successfully treated. After demonstrating the success of the procedure, the DRO interval was increased while maintaining the reductions in inappropriate social behaviors. Appropriate behaviors such as initiating conversation, shaking hands, etc maintained throughout the intervention. Copyright © 2000 John Wiley & Sons, Ltd.     

A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings

A modified skills training component of dialectical behavior therapy (DBT) was implemented in a group therapy format for non-suicidal outpatient young adolescents who met criteria for oppositional defiant disorder (ODD). Thirty-two youths completed the 16-week program, as well as pre- and post-treatment measures. The treatment was effective not only in decreasing negative behaviors, but also in increasing positive behaviors, per caregiver report. The youths reported a significant reduction in externalizing and internalizing symptoms and in depression. Reliable change indices indicated that far more participants were in the improved category than in the deteriorated category on the measures of interest. Despite the absence of control groups but consistent with the treatment outcome research literature for DBT-based treatments for other disorders, this study demonstrated that DBT skills training is feasible and shows promise in improving the behavior of ODD young adolescents.     

A comparison of procedures for eliminating self-injurious behavior of retarded adolescents

An attempt was made to eliminate the self-injurious behaviors of four institutionalized, profoundly retarded adolescents. Some of the behaviors studied were: face-slapping, face-banging, hair-pulling, face-scratching, and finger-biting. Three remediative approaches to self-injurious behavior were compared. Elimination of all social consequences of the self-injurious behavior was not effective with the two subjects with whom it was attempted. The same two subjects were exposed to a procedure involving reinforcement of non-self-injurious behavior which was ineffective under no food deprivation and was effective with one of the two subjects under mild food deprivation. Electric-shock punishment eliminated the self-injurious behaviors of all four subjects with whom it was attempted. The results suggested that punishment was more effective than differential reinforcement of non-self-injurious behavior which, in turn, was more effective than extinction through elimination of social consequences. However, the effects of the punishment were usually specific to the setting in which it was administered. In order to eliminate the self-injurious behaviors of severely retarded children, it is apparently necessary to carry out the treatment in many of the settings in which it occurs.     

THE INFLUENCE OF CHILD-PREFERRED ACTIVITIES ON AUTISTIC CHILDREN'S SOCIAL BEHAVIOR

One of the characteristics of autistic children is severe social avoidance behavior. We assessed whether the type of activity (child-preferred vs. activities that were arbitrarily determined by an adult) engaged in during an interaction was correlated with the amount of social avoidance behaviors these children exhibit. Results revealed a negative correlation between appropriate child-preferred activities and social avoidance behavior. Additional analyses revealed that (a) social avoidance behaviors could be manipulated within a reversal design, and would predictably decrease when the children were prompted to initiate appropriate child-preferred activities; and (b) these procedures could be used to teach children to initiate child-preferred activities in community settings, resulting in reductions in social avoidance responses even after the therapist's prompts were completely removed. These data suggest that the manipulation of task variables may influence the severe social unresponsiveness that is characteristic of autistic children.     

The effectiveness of contingent restraint on aggression,self-injury,and property destruction of institutionalized mentally retarded persons

This study was a retrospective evaluation of in place treatment procedures. Clinical data were reviewed from 45 cases in which contingent restraint was employed in an effort to modify the inappropriate behaviors of institutionalized mentally retarded persons. Statistically significant decrements in the rates of inappropriate behavior were detected over the 18 months of study. Clinically meaningful improvement in the rates of behavior were detected in 53% of the cases in which the target behavior was either aggression, selfinjury, or property destruction. The inclusion of less serious behaviors in the study did not substantially increase this rate. Effectiveness appeared to be more pronounced for males, younger persons, persons with short institutional tenures, and persons who were free from psychotropic medication during the course of treatment.