A Social Stories intervention package for students with autism in inclusive classroom settings

A Social Stories intervention package was used to teach 2 students with autism to read Social Stories, answer comprehension questions, and engage in role plays. Appropriate social behaviors increased and inappropriate behaviors decreased for both participants, and the effects were maintained for up to 10 months. This intervention package appears to be useful in inclusive classroom environments and does not require intensive supervision of the child's behavior.     

Instructive feedback embedded within group instruction for children diagnosed with autism spectrum disorder

The present study evaluated the effects of instructive feedback embedded within a group discrete trial teaching to teach tact relations to nine children diagnosed with autism spectrum disorder using a nonconcurrent multiple‐baseline design. Dependent variables included correct responses for: primary targets (directly taught), secondary targets (taught via instructive feedback), primary observational targets (directly taught to other members of the group), and secondary observational targets (taught via instructive feedback provided to other members of the group). Results showed that all nine participants reached the mastery criterion for the primary targets, as well as acquired the secondary and observational targets without direct teaching. Clinical implications and areas for future research are provided.     

Use of normative peer data as a standard for evaluating classroom treatment effects

This study illustrated the use of normative behavioral observation data as a standard for evaluating the practicality of treatment effects produced in other settings. Three groups of eight subjects each, displaying relatively low proportions of appropriate classroom behavior when compared with regular classroom peers, were selected for treatment within an experimental classroom setting. The three groups were exposed to intervention procedures designed to reinforce either direct academic performance and/or facilitative nonacademic classroom responses. The treatment was effective in changing levels of appropriate behavior (1) above baseline levels in the experimental classroom, and (2) to within normal peer-defined limits when reintegrated into the regular classroom. Further, the data reflect successful maintenance of these effects for a seven- to 12-week follow-up period. Several applications of a normative model for evaluating treatment, generalization, and maintenance effects were presented and discussed.     

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

Assessment and treatment of high-risk challenging behavior of adolescents with autism in an aquatic setting

Aquatic-based activities produce positive skill and health benefits for individuals with Autism Spectrum Disorder (ASD); however, aquatic contexts, such as the pool, introduce the risk of injury and drowning. This risk is heightened when individuals with ASD engage in challenging behavior in the pool context. The purpose of the study was to evaluate the effects of differential reinforcement without extinction for 2 participants diagnosed with ASD who engaged in challenging behavior when asked to transition from the pool. The treatment successfully decreased participants' transition latencies and challenging behavior during transitions from the pool for up to 2 months following treatment. Lifeguard staff rated the procedures as highly acceptable and helpful, and noted high degrees of satisfaction with improvements for each participant's behavior.     

Parent treatment of complex pica in a teen with autism

Pica is a severe behavior disorder involving the persistent consumption of nonnutritive substances. Due to health complications and risks for fatality, designing effective behavioral treatments that are feasible for implementation by family members at home is imperative. This case report presents a parent-conducted functional analysis and treatment evaluation of automatically maintained pica in a teenager with autism spectrum disorder. Initial treatment with a competing stimulus was effective when paired with response interruption and redirection. Although effective, this combination of treatment components required very close parental proximity and led to increases in untargeted body-oriented pica (e.g., ingestion of skin, hair, and nails). Upon extending treatment to include the second topography of pica, both the originally targeted (object-oriented) pica and body-oriented pica decreased. Nonetheless, treatment effects were not sustained while fading parent proximity. The treatment was then augmented a third time with response cost. This final treatment package produced clinically significant reductions in all pica, facilitated parent proximity fading until the participant was alone, extended to their home, and maintained over a year of follow up.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Effects of training, prompting, and self-monitoring on staff behavior in a classroom for students with disabilities

This study extended the limited research on the utility of tactile prompts and examined the effects of a treatment package on implementation of a token economy by instructional assistants in a classroom for students with disabilities. During baseline, we measured how accurately the assistants implemented a classroom token economy based on the routine training they had received through the school system. Baseline was followed by brief in-service training, which resulted in no improvement of token-economy implementation for recently hired instructional assistants. A treatment package of prompting and self-monitoring with accuracy feedback was then introduced as a multiple baseline design across behaviors. The treatment package was successfully faded to a more manageable self-monitoring intervention. Results showed visually significant improvements for all participants during observation sessions.     

Embedding an identity-matching task within a prompting hierarchy to facilitate acquisition of conditional discriminations in children with autism

Least-to-most prompting hierarchies (e.g., progressing from verbal to modeled to physical prompts until the target response occurs) may be ineffective when the prompts do not cue the individual to attend to the relevant stimulus dimensions. In such cases, emission of the target response persistently requires one or more of the higher level prompts, a condition called prompt dependence (Clark & Green, 2004). Reinforcement of differential observing responses (DORs) has sometimes been used to ensure that participants attend to the relevant stimulus dimensions in matching-to-sample (MTS) tasks (e.g., Dube & McIlvane, 1999). For 2 participants with autism, we embedded an identity-matching task within a prompting hierarchy as a DOR to increase the likelihood that the participants attended to and discriminated the relevant features of the comparison stimuli in an MTS task. This procedure was compared with a traditional least-to-most prompting hierarchy and a no-reinforcement control condition in a multielement design. Results for both participants indicated that mastery-level acquisition of spoken-word-to-picture relations occurred only under the identity-matching condition. Findings are discussed relative to the use of DORs to facilitate acquisition of conditional discriminations in persons with autism or other conditions who do not attend to the comparison stimuli.     

The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting

There are few long-term follow-up studies on psychological treatment of anxiety disorders carried out in clinical mental health settings, so called effectiveness studies. The present paper presents a four year follow-up of patients with obsessive-compulsive disorder treated by the Bergen 4-day treatment (B4DT), a concentrated form of exposure and response prevention (ERP). A total of 77 obsessive–compulsive disorder (OCD) patients received treatment during four consecutive days and were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pre, post, and at follow-ups after 3 and 6 months, and 4 years post-treatment. The Y-BOCS mean score changed from 25.9 at pre- to 10.0 post-treatment and 9.9 at long-term follow-up. The proportion fulfilling the strict international consensus criteria for remission was 73% at post-treatment and 69% at follow-up. When taking declining rate, attrition rate, remission, relapse, and further improvement during the follow-up period into account, 72% were recovered on a long-term basis. A comparison with previously published effectiveness studies of ERP indicated that the 4-day treatment yielded significantly higher proportions of remission at post-treatment and recovery at follow-up, as well as within-group effect size on the Y-BOCS. The implications of these results are discussed.     

Using analog assessment procedures for determining the effects of a gluten‐free and casein‐free diet on rate of problem behaviors for an adolescent with autism

The behavioral effects of a gluten/casein‐free diet were evaluated for an adolescent with autism who displayed several forms of aberrant behavior. An analog assessment was used to measure behavioral response rates within four conditions with type of diet controlled using a BABA design. Results suggested that a gluten/casein‐free diet did not serve as an abolishing operation for assessed problem behaviors. Both the limitations and generality of this finding are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Stimulus fading and differential reinforcement for the treatment of needle phobia in a youth with autism

Stimulus fading in the form of gradually increased exposure to a fear-evoking stimulus, often combined with differential reinforcement, has been used to treat phobias in children who are otherwise normal and in children with autism. In this investigation, we applied stimulus fading plus differential reinforcement with an adolescent with autism and diabetes whose needle phobia had prevented medical monitoring of his blood glucose levels for over 2 years. Results showed that the treatment was successful in obtaining daily blood samples for measuring glucose levels.     

Assessment and treatment of response to name for children with autism spectrum disorder: Toward an efficient intervention model

Response to name (RTN) is an early developmental milestone, deficits in which are associated with autism spectrum disorder (ASD). This study extends previous research by evaluating an assessment and treatment model for RTN with 13 children with ASD. For all participants, phase 1 was a naturalistic social baseline. The 9 children who did not meet mastery criteria in phase 1 underwent a series of treatment conditions in phase 2. In phase 3, treatment components were removed, and generalization was assessed. Results indicated that tangible reinforcement procedures can produce rapid increases in discriminated RTN, sometimes without prompts. The total number of trials to mastery were reduced in the current study relative to previous research. Results also provide preliminary evidence to suggest that the phase 1 baseline condition may produce distinct patterns of RTN that could be used to predict treatment effects and further reduce trials to mastery in future work.     

Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase

The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.     

A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

Performance evaluations, need for cognition, and the acquisition of a complex skill: an attribute–treatment interaction

We proposed that intermittent evaluations of performance could be used to promote the acquisition of a complex skill. We also hypothesized that trainees low in need for cognition (NFC) would benefit more from intermittent evaluations compared to trainees high in NFC. Accordingly, 106 young adult males participated in 5 h of training in order to learn a complex computer task that simulated the demands of a dynamic aviation environment. Trainees’ performance was assessed either intermittently during training or at the end of training. Results indicated that intermittent performance evaluations enhanced the skill-based learning of trainees low in NFC, whereas intermittent skill evaluations tended to undermine the skill-based learning of trainees high in NFC. The findings are discussed in relation to Deci’s (1975) theory of intrinsic motivation and the need for more research examining attribute–treatment interactions with respect to training and skill acquisition.     

Cognitive and Behavioral Treatments for Anxiety and Depression in a Patient with an Implantable Cardioverter Defibrillator (ICD): A Case Report and Clinical Discussion

Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.     

Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation

Background: Outcome research has highlighted the efficacy of internet-based cognitive behavioural therapy (iCBT). Some process research has examined users experiences of iCBT. Understanding the user experience provides valuable feedback to developers of internet-delivered interventions.

Aim: The present study aimed to evaluate user's experiences and engagement with the design features of an internet-delivered treatment programme for anxiety.

Methods: Semi-structured interviews were conducted with 7 participant users of the Space from Anxiety programme. A thematic analysis framework was employed to analyse the data collected.

Results: Identified themes related to participants engagement and adherence with the programme material, participant's experience of personal development through interaction with the programme content and participants experience of the social features employed in the programme. Another theme investigated the various attributes or conditions necessary for internet-delivered therapy to be helpful to an individual.

Conclusion: Considering the experiences of users of online interventions provides insight into what works for whom both in terms of technological features and the various skills and strategies that may compose the treatment intervention. Knowing more about what design features and strategies/components of the intervention are attractive and keep users involved can only enhance the delivery of effective internet-delivered interventions for anxiety disorders.