BRIEF HIERARCHICAL ASSESSMENT OF POTENTIAL TREATMENT COMPONENTS WITH CHILDREN IN AN OUTPATIENT CLINIC

Seven parents conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.     

ANALYSIS OF THE EFFECTS OF TASK PREFERENCES,TASK DEMANDS,AND ADULT ATTENTION ON CHILD BEHAVIOR IN OUTPATIENT AND CLASSROOM SETTINGS

Two studies were conducted with children who displayed behavior problems to evaluate the effects of task preference, task demands, and adult attention on child behavior. In Study 1, we conducted brief functional analyses in an outpatient clinic to identify variables that facilitated appropriate behavior. For 8 of 10 children, distinct patterns of performance occurred; 3 children displayed improved behavior with changes in task demands, 1 child displayed improved behavior with a preferred task, and 4 children displayed improved behavior with changes in adult attention. In most cases, the children's parents carried out the assessments with adequate procedural integrity. In Study 2, we applied similar assessment methods to a classroom setting over an extended period of time. We identified independent variables controlling appropriate, on-task, and academic behavior for 2 children on two tasks, with slightly different treatment procedures across tasks for both children. In addition, the results of brief functional analyses for both children corresponded to the extended classroom assessments.     

Parent‐implemented brief functional analysis and treatment with coaching via telehealth

We evaluated the use of parent‐implemented brief functional analyses in the home with coaching delivered via telehealth. Parents of 7 children with autism conducted functional analyses of their child's challenging behavior. For 4 participants, the brief functional analysis provided information regarding the function of the child's challenging behavior. A full functional analysis indicated a social function for 1 participant. The brief functional analysis yielded false positive results and subsequent assessment indicated an automatic function for another participant. The final participant did not engage in sufficient rates of challenging behavior to provide information regarding the function of the child's challenging behavior. Treatment evaluations occurred with 4 participants; these evaluations provided support for the results of the functional analysis. Together with previous research, the results indicate that parent‐implemented brief functional analyses, followed by additional assessment as needed, may be an effective method for assessing and treating challenging behavior via telehealth.     

金钱激励在社会排斥影响不确定性决策中的调节作用

研究从金钱补偿的视角考察社会排斥对不确定性决策的影响以及金钱激励的调节作用。实验发现,有金钱激励时,被排斥者在爱荷华赌博任务(Iowa gambling task,IGT)中的行为分数(组块2和3的选牌净分数和总的盈利分数)显著高于社会接纳者,表现为风险规避; 在无金钱激励时,被排斥者在IGT任务中的行为分数(组块4和5的选牌净分数和总的盈利分数)显著低于被接纳者,表现为风险寻求。实验结果表明社会排斥对不确定性决策的影响受到金钱激励的调制。     

Using Structural Analysis in Natural Settings: A Responsive Functional Assessment Strategy

Since the reauthorization of IDEA (1997), the use of functional assessments to examine factors that are related to students challenging behaviors has gained increasing attention in the literature. Over the past five years, several groups of investigators have conducted systematic analyses of the current status of the use of functional assessment in relation to students with or at risk for emotional/behavioral disorders (EBD). Their findings outline a number of critical, applied research issues for the field to consider. The purpose of this paper is to respond to a number of these issues by highlighting the relevance of structural analysis in addition to and in some cases in lieu of more traditional functional assessments. A brief review of current trends in the functional assessment research is presented as well as a rational for the use of structural analysis to examine the occurrence of appropriate behavior for students with EBD. Finally, illustrations of studies conducting structural analyses in classrooms settings are provided.     

An Evaluation of a Brief Multiple-Stimulus Without Replacement Preference Assessment Conducted in an Electronic Pictorial Format

We compared the results of a brief electronic pictorial multiple-stimulus without replacement (EP-MSWO) preference assessment to a brief tangible MSWO preference assessment in five children with autism. Results of both assessments yielded a match between high preferred (HP) toys for four participants and low preferred toys for three participants. The overall correlation between assessments across participants was strong and statistically significant (ρ = .67, p < .01). A reinforcer assessment conducted with three participants confirmed HP toys identified in the EP-MSWO functioned as reinforcers.     

Behavioral Telehealth Consultation with Families of Children with Autism Spectrum Disorder

In this study, desktop video teleconferencing was used to facilitate behavioral consultation at a distance with three parents of school‐age children with autism spectrum disorders. Parents were supported via desktop video teleconferencing as they conducted functional analyses and learned to implement an antecedent manipulation strategy, functional communication training, and a consequence‐based strategy. Parents then conducted a brief multi‐element treatment comparison to evaluate the preliminary effectiveness of each intervention strategy on their child's challenging behavior. The results of this study provide additional support to previous research suggesting that a telehealth model of behavioral consultation may be an effective way to assist parents of children with autism spectrum disorders address challenging behavior that disrupts family routines. Suggestions for future research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients.

An experimental components analysis of brief HIV risk-reduction counseling based on the information-motivation-behavioral skills (IMB) model was conducted with 432 men and 193 women receiving sexually transmitted infection (STI) clinic services. Following baseline assessments, participants were randomly assigned to 1 of 4 90-min risk-reduction counseling sessions that deconstructed the IMB model within a full factorial design. Participants were followed for 9 months, with STI diagnoses monitored over 12 months. Men who received the full IMB session evidenced relatively greater use of risk-reduction behavioral skills and relatively lower rates of unprotected intercourse over 6-months follow-up and had fewer new STIs. For women, however, the motivational counseling demonstrated the most positive outcomes. Results suggest that brief single-exposure HIV prevention counseling can reduce HIV transmission risks.     

Effects of Signaled Positive Reinforcement on Problem Behavior Maintained by Negative Reinforcement

We evaluated the effects of providing positive reinforcement for task completion, signaled via the presence of a tangible item, on escape-maintained problem behavior displayed by three typically developing children during one-time 90-min outpatient evaluations. Brief functional analyses of problem behavior, conducted within a multielement design, identified negative reinforcement. Treatment, conducted within a nonconcurrent multiple baseline with reversal design, consisted of a signal for positive reinforcement while continuing to permit escape for problem behavior, thus creating a competition between positive and negative reinforcement. For all participants, problem behavior decreased.     

EVALUATION OF A BRIEF STIMULUS PREFERENCE ASSESSMENT

We evaluated the utility of a brief (5-min) stimulus preference assessment for individuals with developmental disabilities. Participants had noncontingent (free) access to an array of stimuli and could interact with any of the stimuli at any time. Stimuli were never withdrawn or withheld from the participants during a 5-min session. In Experiment 1, the brief preference assessment was conducted for 10 participants to identify differentially preferred stimuli, and reinforcer assessments were conducted to test the reinforcing efficacy of those stimuli identified as highly preferred. In Experiment 2, a comparison was conducted between the brief preference assessment and a commonly used paired-stimulus preference assessment. Collectively, results demonstrated that the brief preference assessment identified stimuli that functioned as reinforcers for a simple operant response, identified preferred stimuli that were differentially effective as reinforcers compared to nonpreferred stimuli, was associated with fewer problem behaviors, and required less time to complete than a commonly used paired-stimulus preference assessment.     

The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

Examination of relative reinforcement effects of stimuli identified through pretreatment and daily brief preference assessments.

Several brief preference assessments have recently been developed to identify reinforcers for individuals with developmental disabilities. One purported advantage of brief assessments is that they can be administered frequently, thus accommodating shifts in preference and presumably enhancing reinforcement effects. In this study, we initially conducted lengthy paired‐choice preference assessments and identified a hierarchy of preferred items for 5 individuals with developmental disabilities. Subsequently, brief multiple‐stimulus‐without‐replacement assessments using the same items were completed each day prior to work sessions. On days when results of the daily brief assessment differed from the one‐time lengthy assessment, the relative reinforcing effects of the top items from each assessment were compared in a concurrent‐schedule arrangement. The results revealed that when the two assessments differed, participants generally allocated more responses to the task associated with the daily top‐ranked item.     

Evaluation of a brief multiple-stimulus preference assessment in a naturalistic context

We evaluated a brief multiple-stimulus preference assessment within the context of an early intervention program for 3 children who had been diagnosed with autism. Subsequent curriculum-based reinforcer evaluations confirmed the predictions of the preference assessments. In addition, eight additional preference assessments that were conducted over a period of 1 month indicated generally stable preferences for 2 of the 3 participants.     

A Brief Experimental Analysis of Reinforcer and Response Dimensions Related to Self-Control in an Outpatient Clinic

We conducted an assessment of self-control and impulsivity with 9 children referred to an outpatient clinic for impulsive, inattentive, and hyperactive behaviors. Each condition of the assessment consisted of a choice between 2 concurrently presented math or writing tasks, with 1 alternative reflecting impulsive responding and 1 alternative reflecting self-control. For the participants who demonstrated impulsive responding in 1 of 2 baseline conditions, we systematically varied reinforcer quality, delay to reinforcement, and response effort to evaluate the effects of these dimensions on the participants’ choices. Results of the assessment revealed that 3 participants displayed self-control responding, and 6 participants displayed impulsive responding during baseline conditions. Of the participants who displayed initial impulsivity, all showed self-control when 1 or more response or reinforcement dimensions were modified to bias responding within a brief multielement design. Results provide a unique application of concurrent schedules for conducting a brief assessment of impulsive responding in an outpatient clinical setting.     

Randomized controlled trial of brief interventions to reduce college students' drinking and risky sex

The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.     

A Comparison of Function-Based Differential Reinforcement Interventions for Children Engaging in Disruptive Classroom Behavior

This study provides a direct comparison of differential reinforcement of other behavior (DRO) and differential reinforcement of alternative behavior (DRA). Participants included three children in center-based classrooms referred for functional assessments due to disruptive classroom behavior. Functional assessments included interviews and brief functional analyses. An alternating treatments design was used to evaluate the relative effectiveness of function-based DRO and DRA interventions. Results indicated that both intervention procedures effectively reduced disruptive behavior, but the DRA procedure consistently resulted in greater reductions in disruptive behavior across all participants. Results are discussed in terms of directions for future functional assessment and intervention research as well as implications for applied practice.     

A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

OBJECTIVE: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine. METHOD: One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood. RESULTS: Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance. CONCLUSIONS: CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.     

Using an abbreviated assessment to identify effective error‐correction procedures for individual learners during discrete‐trial instruction

Previous research comparing the effectiveness of error‐correction procedures has involved lengthy assessments that may not be practical in applied settings. We used an abbreviated assessment to compare the effectiveness of five error‐correction procedures for four children with autism spectrum disorder or a developmental delay. During the abbreviated assessment, we sampled participants' responding with each procedure and completed the assessment before participants reached our mastery criterion. Then, we used the results of the abbreviated assessment to predict the most efficient procedure for each participant. Next, we conducted validation assessments, comparing the number of sessions, trials, and time required for participants to master targets with each procedure. Results showed correspondence between the abbreviated assessment and validation assessments for two of four participants and partial correspondence for the other two participants. Findings suggest that a brief assessment may be a useful tool for identifying the most efficient error‐correction procedure for individual learners.     

Evaluating the Effectiveness of an Abduction Prevention Program for Young Adults With Intellectual Disabilities

The purpose of this study was to evaluate the effectiveness of behavioral skills training (BST) and in situ training (IST) for teaching abduction prevention skills to young adults with intellectual disabilities. Four individuals, ages 18–24, participated. Five BST sessions were conducted for each participant. Following BST, in situ assessments took place at the participants’ school to assess acquisition of the skills. The data show that none of the participants reached criterion level following BST although some of the participants improved their score from baseline. IST was then implemented with two of the participants achieving criterion level and two participants exhibiting two of the three safety skills.