Brief assessment and treatment of pica using differential reinforcement,response interruption and redirection,and competing stimuli

Pica is a life threating form of challenging behavior displayed by individuals with intellectual and developmental disabilities. In most cases, pica is maintained by automatic reinforcement. Common interventions for pica use some combination of response blocking, response interruption and redirection (RIRD), differential reinforcement of alternative behavior (DRA), and noncontingent reinforcement with competing stimuli. However, there is need for additional research regarding DRA procedures that emphasize skills acquisition by teaching alternative behaviors that modify the established behavioral chain of pica responses that occur in the presence of non-edible stimuli. There is also a need to examine the generality of recent advances in competing stimulus assessment (CSA) methodologies—namely, the augmented-CSA (A-CSA)—to pica. Thus, the purpose of the present investigation was to systematically replicate and extend previous research for the assessment and treatment of pica in an individual with IDD. First, we conducted a functional analysis to identify environmental variables associated with pica. Next, taught Patrick a differential response (i.e., discard pica items in trash receptacle) to earn reinforcers in conjunction with a RIRD procedure. Finally, we conducted an A-CSA for pica. Overall, low rates of pica were maintained over time with a combination of these procedures, and treatment was generalized across settings and people.     

Functional assessment and treatment of pica: a single‐case experiment

The pica of a 6‐year‐old girl diagnosed with autism was initially shown to persist in the absence of socially mediated consequences. In an attempt to provide a competing source of oral stimulation, we used a stimulus preference assessment to identify food items that were subsequently presented noncontingently. However, the noncontingent schedule could not be thinned to a practical variation while still maintaining reductions in pica. A subsequent multielement evaluation of response blocking and verbal reprimands demonstrated that neither intervention both produced and maintained low levels of pica. Verbal reprimands were then used in conjunction with noncontingent food presentation, but this intervention did not produce significant reductions in pica. Suppression of pica was ultimately obtained in both a clinic setting and in the child's natural environment using contingent, varied auditory stimulation. The results are discussed in the context of the ‘least restrictive alternative’ model of treatment selection. Copyright © 2001 John Wiley & Sons, Ltd.     

Varying response effort in the treatment of pica maintained by automatic reinforcement

Pica is a life-threatening behavior displayed by many individuals with developmental disabilities. In the current study, automatic reinforcement maintained the pica of 3 participants. Following functional analyses of pica, response-effort manipulations were conducted in which the effort to obtain pica or alternative items was varied systematically. Several general relations emerged as a result of the study. First, levels of pica were reduced relative to baseline when alternative items were available independent of the effort required to obtain alternative items or pica. Second, increasing the effort for alternative items resulted in increases in pica relative to when effort for alternative items was low. Third, increasing response effort for pica produced reductions in pica relative to baseline when alternative items were unavailable. Fourth, the highest levels of pica occurred when the effort to engage in pica was low or medium and no alternative items were available. These findings are discussed in terms of the relative effects of quality of reinforcement and response effort on behavior.     

A long-term case study with sadistically-tinged countertransference elements

The American Journal of Psychoanalysis - This case report sketches the psychoanalytically-informed supportive psychotherapeutic treatment of a single man through his life challenges over a...     

Time-series analysis of long-term cardiovascular response

The purpose of this study was to illustrate the use of time-series analysis with long-term cardiovascular responding. Analyses of two successive 1000-minute mean blood pressure and heart-rate series in five chronically instrumented dogs showed that the autocorrelation function of the original series appeared highly nonstationary and that differencing the data produced a simple autocorrelation pattern which could be successfully modeled with stepwise autoregression. Evidence for reliable individual differences as well as change over sessions is presented and discussed.     

A placebo stimulus for the assessment and treatment of pica for tobacco

A detailed procedure for making placebo cigarette butts or “bogus butts” which can be used in the observation and treatment of pica for cigarettes is described. These placebo cigarette butts have been used successfully with several individuals in a residential treatment setting. The use of these bogus butts allows the clinician/researcher to use a stimulus object which can be safely ingested, thus permitting a functional analysis of the target behavior as well as assessment of potential treatment approaches without the possible interference and confound of a prevention procedure such as physically removing the pica material before it is consumed, limiting the length of baseline, or intervening during the baseline.     

Control and maintenance effects of long-term relaxation training in a case of hypertension

The effects of long-term, varied relaxation in a case of essential hypertension are described. The client's unusual achievement of voluntary control over his blood pressure was discussed in terms of new directions in the search of a relaxation specific factor.     

Individual,family, and societal dimensions of genetic discrimination: A case study analysis

Background. As the development and use of genetic tests have increased, so have concerns regarding the uses of genetic information. Genetic discrimination, the differential treatment of individuals based on real or perceived differences in their genomes, is a recently described form of discrimination. The range and significance of experiences associated with this form of discrimination are not yet well known and are investigated in this study. Methods. Individuals at-risk to develop a genetic condition and parents of children with specific genetic conditions were surveyed by questionnaire for reports of genetic discrimination. A total of 27,790 questionnaires were sent out by mail. Of 917 responses received, 206 were followed up with telephone interviews. The responses were analyzed regarding circumstances of the alleged discrimination, the institutions involved, issues relating to the redress of grievances, and strategies to avoid discrimination. Results. A number of institutions were reported to have engaged in genetic discrimination including health and life insurance companies, health care providers, blood banks, adoption agencies, the military, and schools. The alleged instances of discrimination were against individuals who were asymptomatic and sometimes impacted on other asymptomatic relatives. Few surveyed respondents knew of the existence of institutions such as state insurance commissions or the Medical Information Bureau, Inc., which may play roles in redress of grievances or correction of misinformation. Conclusions. Genetic discrimination is variable in form and cause and can have marked consequences for individuals experiencing discrimination and their relatives. The presence of abnormal genes in all individuals makes each person a potential victim of this type of discrimination. The increasing development and utilization of genetic tests will likely result in increased genetic discrimination in the absence of contravening measures. All authors contributed equally to this work. This work was supported by a grant from the U.S. Department of Energy and funding from the Department of Mental Retardation of the Commonwealth of Massachusetts.     

Cotherapy treatment of phobias: A case study

A case study is presented of the treatment of a woman who had suffered from claustrophobia for over 13 years, by cotherapists using a combination of desensitization and flooding techniques. By assuming specific roles, the therapists expedited the therapeutic process to a successful conclusion in a brief period of time.     

Setting and response generalization in rational-emotive therapy: A case study

A single case study (n=1) conducted during therapy investigated the relationship between disputing irrational beliefs in vivo and setting and response generalization. Irrational beliefs associated with the subject's anger and depression were disputed at different intervals over a ten week period utilizing a multiple baseline design across four classes in a school setting (setting 1). Depression and anger were rated several times each week. The subject's level of anxiety was also rated in setting 1 but the irrational beliefs associated with it were not disputed. Anger, depression, and anxiety were rated without disputation in a separate work setting (setting 2). Affect ratings significantly decreased across both settings throughout the ten week period. Results indicated that 1) disputing irrational beliefs associated with anger and depression in setting 1 led to reductions in anxiety in this setting (response generalization), 2) anger and depression reductions in setting 2 paralleled setting 1 reductions (setting generalization), and 3) anxiety reductionsWilliam J. Ruth, PhD, Staff Psychologist and practicum supervisor, Institute for Rational-Emotive Therapy, NY City; School Psychologist, Board of Cooperative Educational Services, Southern Westchester.Raymond DiGiuseppe, PhD, ABPP, Director of Training and Research, Institute for Rational-Emotive Therapy, NY City; Graduate Professor, St. John's University, NY City; co-author,Practitioner's Guide to Rational-Emotive Therapy and RET with Alcoholics and Substance Abusers.     

Sequential analysis of the numerical Stroop effect reveals response suppression

Automatic processing of irrelevant stimulus dimensions has been demonstrated in a variety of tasks. Previous studies have shown that conflict between relevant and irrelevant dimensions can be reduced when a feature of the irrelevant dimension is repeated. The specific level at which the automatic process is suppressed (e.g., perceptual repetition, response repetition), however, is less understood. In the current experiment we used the numerical Stroop paradigm, in which the processing of irrelevant numerical values of 2 digits interferes with the processing of their physical size, to pinpoint the precise level of the suppression. Using a sequential analysis, we dissociated perceptual repetition from response repetition of the relevant and irrelevant dimension. Our analyses of reaction times, error rates, and diffusion modeling revealed that the congruity effect is significantly reduced or even absent when the response sequence of the irrelevant dimension, rather than the numerical value or the physical size, is repeated. These results suggest that automatic activation of the irrelevant dimension is suppressed at the response level. The current results shed light on the level of interaction between numerical magnitude and physical size as well as the effect of variability of responses and stimuli on automatic processing.     

A case study report on integrating statistics, problem-based learning, and computerized data analysis

This paper addresses the pedagogical advantages of teaching statistics not as a stand-alone subject in itself, but rather as a topic integrated into teaching hands-on, problem-based computer-assisted data analysis. For over 10 years, such a two-term course has been taught at Drexel University in lieu of the usual statistics courses formerly taken by undergraduate majors in psychology and sociology. One virtue of the courses as currently implemented is that students seem to learn not just how to perform statistical procedures but how to apply them on their own.     

Cluttering: Assessment, treatment planning, and case study illustration

Successful treatment of clients who present with a multitude of interrelated impairments is frequently dependent upon thorough and accurate diagnosis of the problems. Individuals who clutter often demonstrate a variety of speech and language deficits that make diagnosis difficult. Two clinical tools believed to be useful for obtaining and organizing diagnostic data and for planning treatment with clients who show symptoms of cluttering are discussed. The case study report illustrates the utility of these tools for collecting and organizing all pertinent data.     

Ethical dimensions of diagnosis: A case study and analysis

A rational reconstruction of the role of moral values in diagnostic reasoning is undertaken. In the context of a case study it is shown how value and ethical considerations come into play in the complex course of making diagnostic and therapeutic decisions.     

Very long-term retention of a first language without rehearsal: A case study

A case study is presented of an American sign language-using deaf woman whose life circumstances were such that she had no opportunities to use her sign language over nearly 40 years, but whose recall of its lexicon and syntax were almost unimpaired when she resumed its use after that period. Implications for the role of memory in first language learning are compared with results for second languages, and the role of rehearsal and interference in remembering over very long periods is considered.