Behavioral momentum and stimulus fading in the acquisition and maintenance of child compliance in the home

The provision of a series of requests to which compliance is highly likely (high-probability requests) immediately antecedent to low-probability requests has been used to establish behavioral momentum of compliance. We evaluated a fading procedure for maintaining high levels of compliance obtained with high-probability requests. Fading involved a systematic reduction in the number of high-probability requests and an increase in the latency between the high- and low-probability requests. High levels of compliance for both "do" and "don't" requests were maintained for 16 weeks in a 5-year-old boy with developmental disabilities after the high-probability request sequence was faded. Similar maintenance was obtained for "do" requests in a 15-year-old girl with developmental disabilities. For this subject, however, the high-probability request sequence was ineffective with "don't" requests. When "don't" requests were phrased as "do" requests, the high-probability request sequence produced high levels of compliance to the low-probability request. High levels of compliance to these "do" requests were maintained for 16 weeks after the high-probability request sequence was faded.     

The effects of varying levels of treatment integrity on child compliance during treatment with a three-step prompting procedure

The effects of three levels of treatment integrity (100%, 50%, and 0%) on child compliance were evaluated in the context of the implementation of a three-step prompting procedure. Two typically developing preschool children participated in the study. After baseline data on compliance to one of three common demands were collected, a therapist implemented the three-step prompting procedure at three different integrity levels. One integrity level was associated with each demand. The effects of the integrity levels were examined using multielement designs. The results indicate that compliance varied according to the level of treatment integrity that was in place.     

Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. Overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.     

Further analysis of modifications to the three-step guided compliance procedure to enhance compliance among children with autism

Three-step guided compliance (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) is a commonly used procedure to increase compliance among children with intellectual disabilities. Previous research has suggested that under some conditions, slight modifications to the three-step procedure may enhance its effectiveness. These modifications include omitting the model prompt and decreasing the interprompt interval. In the current study, we evaluated another modification to the procedure: the delivery of a high-preference item contingent upon compliance with the first vocal prompt (i.e., differential reinforcement). For 2 participants with autism, compliance remained low when we implemented differential reinforcement and the guided compliance procedure in isolation. However, compliance improved when we combined differential reinforcement and the three-step guided procedure, suggesting that for at least some children, the combination of contingent access to a high-preference item and the guided compliance procedure is more effective than either intervention alone.     

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.     

The effects of a high-probability instruction sequence and response-independent reinforcer delivery on child compliance

We compared the effects of a high-probability (high-p) instruction sequence and a fixed-time (FT) schedule of reinforcement on the compliance of 2 typically developing children. A multielement experimental design with a reversal component was implemented according to a multiple baseline across participants arrangement. Both the high-p and FT conditions resulted in increased compliance for both participants during the multielement sessions. These results suggest that it may be possible to increase compliance without a response requirement of the type arranged in the high-p instruction sequence.     

Increasing compliance with haircuts in a child with autism

Using a changing‐criterion design, we evaluated the effects of providing a preferred edible item and escape from sitting contingent on a child's compliance with sitting during haircuts. Results indicated that the intervention eliminated the child's escape responses and increased his sitting to a duration that permitted regular haircuts by his mother. Follow‐up sessions showed that the participant's increased compliance during haircuts continued for over 2 months. Copyright © 2010 John Wiley & Sons, Ltd.     

Exposure-based treatment to control excessive blood glucose monitoring.

We investigated an exposure‐based procedure for reducing excessive checking of blood glucose by a child with diabetes. In a changing criterion design, an exposure‐based procedure was implemented by systematically exposing the child to decreasing amounts of information about blood sugar levels (checking) and thereby increasing exposure to potential hypoglycemia. Access to information was reduced in graduated increments, with the parents setting criteria to levels at which they were willing to adhere. Results demonstrated that the procedure was effective in reducing excessive blood glucose checking and in improving metabolic control.     

Behavioral assessment of methylphenidate in a child with frontal lobe damage

The assessment and management of inattentive, hyperactive, and impulsive behavior in a 6-year-old girl who experienced frontal lobe damage are described. A multimodel approach combining medical, educational, and behavioral techniques to assess hyperactive behavior, optimal medication level, and medication and psychotherapeutic effectiveness is described. The results of the study suggest that in similar cases, children and adolescents manifesting these behaviors should be given a trial of stimulant medication in a controlled environment to assess if such therapy is indicated. Additional support is given for the increasing need for detanté and cooperation with health-care professionals.     

Establishing compliance with liquid medication administration in a child with autism

Children with autism often display difficulty with swallowing pills and liquid medications. In the current study, stimulus fading and positive reinforcement established compliance with liquid medication administration in a young boy with autism. The boy's mother eventually administered liquid medication on her own.     

The role of contextual variables in maternal reactions to children's compliance and noncompliance

The present study was designed to assess whether certain contexts influenced material reactions to children's compliant and noncompliant behavior. Study 1 examined the following contextual variables: chronic negative conditions of the child (physical illness and psychological disturbance) and recent life events experienced by the child (both positive and negative). Study 2 examined maternal mood states as another contextual variable. Results indicated that these contexts relate to differential choices of discipline techniques, based on maternal self-report. These data are examined in light of the literature on treatment acceptability and are discussed in terms of a signal-detection model. Clinical applications are addressed, and suggestions for future research are offered.Portions of this paper were presented at the meeting of the Association for Advancement of Behavior Therapy, Philadelphia, November 1984.We express gratitude to the Research Council of the University of North Carolina at Greensboro for Research Council Grant 2110 218 00000 7719 and to the following for their assistance: James Herbert, Nancy Quinn, Carol Roberson, Ira Turkat, and Marilyn Williams.     

Changes in behavioral problems and prosocial functioning in child treatment

Decreasing emotional and behavioral problems and increasing prosocial functioning are two ares of interest in child treatment. The present study examined the extent to which changes in deviant behavior were associated with changes in prosocial functioning. Three separate samples of children (N = 393, ages 6–13) referred to inpatient or outpatient services were evaluated by parents and teachers on three separate assessment occasions spanning 1–2 years. The major findings indicated that behavioral problems and prosocial functioning and changes in behavioral problems and prosocial functioning over time showed low to moderate negative correlations for parent and teacher evaluations. These relations were consistent across separate time periods, samples of children, and parent and teacher ratings. The magnitude of the correlations between behavioral problems and prosocial functioning indicated that these domains are related but represent relatively independent spheres of child functioning. The importance of assessing both domains of functioning in evaluating children and treatment outcome is discussed.     

Proximal and distal effects of play on child compliance with a brain-injured parent.

Individuals with brain injury may experience severe cognitive and other impairments. For brain‐injured parents, such deficits may be associated with child behavior problems, including noncompliance. We assessed the effects of a play period conducted by a brain‐injured father on the compliance of his son, who had become uncooperative with his father after the injury. The child consistently demonstrated improved compliance during proximal and distal compliance sessions that followed father‐son play periods.     

Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.     

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.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.     

An evaluation of the high-probability instruction sequence with and without programmed reinforcement for compliance with high-probability instructions

We assessed the effects of reinforcement and no reinforcement for compliance to high-probability (high-p) instructions on compliance to low-probability (low-p) instructions using a reversal design. For both participants, compliance with the low-p instruction increased only when compliance with high-p instructions was followed by reinforcement. These results suggest that providing reinforcement for high-p instructions may result in increased compliance to low-p instructions.     

Case study: Reinforcement control of assaultive behavior in a sensory impaired child

This clinical case study describes the residential treatment of severe assaultive behavior in a 13-year-old sensory impaired child using two methods of positive reinforcement. Only slight reductions in the frequency of assaults occurred when the child was reinforced for compliance with task demands. Control was established quickly when reinforcement for the absence of responding was programmed in the form of a differential reinforcement of other behavior (DRO) contingency. Treatment fading was accomplished by gradually decreasing the immediacy and frequency of reinforcement. Extended follow-up assessment revealed near-zero levels of responding.     

Reproductive issues in adults with cystic fibrosis: Implications for genetic counseling

This article reviews reproductive issues faced by the growing number of individuals with cystic fibrosis (CF) who reach adulthood. Approximately 97–98% of males with CF are infertile and they may have an increased risk for genitourinary anomalies. Females with CF may experience delayed puberty, irregular menstrual cycles, and decreased fertility. Women with CF who have good clinical scores, good nutritional status, and normal lung volumes with mild to moderate airway obstruction, have a better chance for successful pregnancies. The role of the genetic counselor in counseling adults with CF is discussed and resources for CF adults are provided.