Brief functional anlaysis and treatment of elopement in preschoolers with autism

As a result of the impact of functional analysis methodologies in identifying maintaining variables of problem behavior, considerable research has been devoted to tailoring the methodologies to be practical for an outpatient setting. The purpose of this study was (a) to use brief functional analysis (BFA) methodologies to empirically demonstrate the function of elopement exhibited by two preschoolers diagnosed with autism and (b) to develop function‐based interventions derived from the results of the BFA. In phase one, a BFA consisting of 5‐min sessions with multiple repetitions of each condition was conducted with each participant. In phase two, the efficacy of function‐based interventions was assessed using a pairwise design. Both participants' rates of elopement were differentially lower during the implementation of the function‐based intervention relative to baseline. Collectively, these results demonstrated that brief functional methodologies could be applied successfully to the assessment and treatment of elopement. Moreover, the application of BFA and the ensuing treatment in an outpatient setting extend the existing research on functional analysis. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison of interventions to treat prompt dependence for children with developmental disabilities

Prior research has examined interventions to prevent prompt dependence from occurring during the training of novel skills. Nevertheless, the relative efficacy and efficiency of different intervention procedures may be idiosyncratic across learners, suggesting the potential benefit of an individualized assessment. The purpose of the current study was to extend the literature on prompt dependence by comparing interventions for 3 participants with developmental disabilities who consistently engaged in correct responses following prompts but did not perform tasks independently. We compared the efficacy and efficiency of 3 interventions including differential reinforcement, prompt fading, and extended response interval. Intervention results differed across participants, indicating that the most efficacious and efficient intervention for prompt dependence should be individualized via assessment.     

Early Maternal Spatial Support for Toddlers and Math Skills in Second Grade

ABSTRACT

The aim of this study is to investigate whether maternal spatial support during two types of joint manipulative toy play tasks with 2-year-old children was longitudinally associated with math screening test scores in second grade. The interaction between spatial support and maternal education was explored as well. We also investigated predictions of a teacher rating of math performance at second grade, although these effects were less robust. Data were drawn from BONDS (The Behavior Outlook Norwegian Developmental Study), a longitudinal study of Norwegian children and their families. Participants were a subsample of 932 mothers and their 2-year-olds. Mothers were asked to help their children solve both a puzzle task and a shape-color sorting task. Mothers’ spatial support included spatial language, gestures, and placement of objects. Results showed that higher levels of spatial support during mother-child interaction tasks at 2 years of age was significantly associated with fewer math difficulties in second grade. This was the case for a puzzle task (a task associated with spatial visualization skills), but not for a shape-color sorting task (a task associated with shape and color feature discriminations). Conclusions are drawn with respect to the importance of identifying optimal parental spatial strategies associated with better math outcomes. These findings on parental facilitation of spatial skills during joint early play may be useful for future training interventions directed at parents of children at risk for poor math skills.     

Dimensional salience and speeded sorting of orientation by kindergarten and fourth-grade children

Perceptual sensitivity and cognitive processing hypotheses relating to orientation perception in kindergarten and fourth-grade children were tested. Assessment of dimensional salience for orientation and form revealed that subjects at both grade levels identified geometric figures as being alike on the basis of form regardless of orientation condition. The effects of dimensional salience and orientation condition on speeded sorting were then investigated. Kindergarten results supported the cognitive processing prediction that orientation sorting times would vary as a function of orientation condition, but no differences were obtained for the fourth-grade subjects. In addition, the results indicated a substantial improvement in kindergarten performance when sorting on the basis of form as compared with orientation. Dimensional salience had much less effect on fourth-grade sorting times.     

The effects of presession exposure to attention on the results of assessments of attention as a reinforcer

The effects of presession exposure to attention on responding during subsequent assessments of attention as a reinforcer were evaluated across three behavioral assessments. In Experiment 1, a contingent attention assessment condition was preceded by either a noncontingent attention condition (free play) or a contingent escape condition. In Experiment 2, a diverted attention with extinction condition was preceded by either an alone or a free-play condition. In Experiment 3, a two-choice preference assessment was preceded by either 10 min of free play or 10 min of playing alone. In each experiment, the participant responded differentially within the test condition according to the presence or absence of dense schedules of attention immediately prior to that condition. The results of this study show that events occurring immediately prior to an assessment condition can influence behavior within the assessment.     

Helping children apply their knowledge to their behavior on a dimension-switching task

To investigate why 3-year-olds have difficulty in switching sorting dimensions, children of 3 and 4 years were tested in one of four conditions on Zelazo's card sort task: standard, sleeve, label and face-up. In the standard condition, children were required to sort blue-truck and red-star cards under either a blue-star or red-truck model card, first by color or shape, and then by the other dimension. Here 3-year-olds sorted correctly until the dimension changed; they continue to sort by the initial dimension. The sleeve condition (placing the sorting cards in an envelope prior to sorting) had little effect. In the label condition, the child labeled the relevant sorting dimension on each trial. Most 3-year-olds succeeded; evidently their labeling helped them refocus their attention, overcoming ‘attentional inertia’ (the pull to continue attending to the previously relevant dimension). In the face-up condition, attentional inertia was strengthened because sorted cards were left face-up; 4-year-olds performed worse than in the standard condition. We posit that attentional inertia is the core problem for preschoolers on the card sort task.     

Examination of efficacious,efficient, and socially valid error‐correction procedures to teach sight words and prepositions to children with autism spectrum disorder

Prior research shows that learners have idiosyncratic responses to error‐correction procedures during instruction. Thus, assessments that identify error‐correction strategies to include in instruction can aid practitioners in selecting individualized, efficacious, and efficient interventions. The current investigation conducted an assessment to compare 5 error‐correction procedures that have been evaluated in the extant literature and are common in instructional practice for children with autism spectrum disorder (ASD). Results showed that the assessment identified efficacious and efficient error‐correction procedures for all participants, and 1 procedure was efficient for 4 of the 5 participants. To examine the social validity of error‐correction procedures, participants selected among efficacious and efficient interventions in a concurrent‐chains assessment. We discuss the results in relation to prior research on error‐correction procedures and current instructional practices for learners with ASD.     

Demonstrating Support for the Formative and Summative Assessment Paradigm in a School-Based Intensive Mental Health Program

We illustrate the use of formative and summative assessment in evaluating a therapeutic classroom program for children with serious emotional disturbances. Information was analyzed based on data gathered for clinical decision-making during treatment (formative assessment) and measurement of outcomes at discharge (summative assessment) from a school-based Intensive Mental Health Program. Results indicated that overall ratings of daily indicators of behavior across all environments (therapeutic classroom, neighborhood school, and home) were predictive of functioning at discharge. An ecological approach during the formative assessment period of evaluation is important as compared to only examining individual environments. Formative assessment techniques can predict scores on a summative assessment measure. Thus, we found supportive evidence for the formative and summative procedures used in the Intensive Mental Health Program for therapeutic interventions, clinical decision-making, and outcomes assessment.     

Long-term effects of appearance-based interventions on sun protection behaviors.

OBJECTIVES: To examine the longer term efficacies of exposure to UV photographs and photoaging information (e.g., wrinkles and age spots) for increasing sun protection intentions and behaviors of young adults. DESIGN: Randomized controlled trial with 4- to 5-month and 12-month follow-ups. MAIN OUTCOME MEASURES: Participants' self-reported sun protection intentions assessed immediately after the interventions, and both self-reported sun protection behaviors and an objective assessment (via spectrophotometry) of skin color change measured at the end of summer (4-5 months following interventions) and 1 year following interventions. RESULTS: Both interventions resulted in immediate positive effects on future sun protection intentions. Both interventions showed objective evidence of less skin darkening at the postsummer follow-up, with those in the photoaging information condition also reporting more sun protective behavior and continuing to show less skin darkening 1 year after intervention. There was also evidence that effects of photoaging information on subsequent skin color change were mediated by the earlier positive effect photoaging information had on participants' intentions to sun protect and their subsequent sun protection behaviors. CONCLUSIONS: UV photo and photoaging-information interventions each show promise as a brief and relatively inexpensive approach for motivating sun protection practices that may reduce skin cancer risk.     

Measuring the reliability of observational data: a reactive process

Reliability of observational data was measured simultaneously by two assessors under two experimental conditions. During overt assessment, observers were told that reliability would be measured by one of the two assessors, thus permitting computation of reliability with an identified and an unidentified assessor. During covert assessment, observers were not informed of the reliability measured. Throughout the study, each of the assessors employed a unique version of a standard observational code. In the overt assessment condition, reliability of observers with the identified assessor was consistently higher than reliability with the unidentified assessor, indicating that observers modified their observational criteria to approximate those of the identified assessor. In the covert assessment condition, reliability with the two assessors was substantially lower than during overt assessment. Further, observers consistently recorded lower frequencies of disruptive behavior than the two assessors during covert assessment.     

Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995)

Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.     

Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

Recognizing the role of parents in developmental outcomes: a systems approach to evaluating the child with developmental disabilities

When developmental concerns arise in children, a clinical assessment focuses on the child's developmental profile to achieve three goals (1) determine diagnosis, (2) develop interventions, and (3) evaluate progress. Parents often have needs during this time that are not addressed by professionals because of the exclusive focus on the child during the evaluation. In this article, we suggest that clinicians take a "systems" approach to the assessment process by recognizing how the well being of family members can impact a child with a developmental disability. We review systems theory and its conceptualization of individual functioning and discuss how parental well-being differs according to child diagnosis. Finally we suggest a systems-based model to use during the assessment process.     

TREATMENT OF SELF-INJURY AND HAND MOUTHING FOLLOWING INCONCLUSIVE FUNCTIONAL ANALYSES

Numerous studies have used functional analyses to prescribe interventions for severe behavior disorders. The majority of these studies have focused on behavior that is clearly maintained by socially mediated reinforcement, such as contingent access to attention, tangibles, or escape from instructional demands. However, a significant proportion of functional analyses do not yield conclusive results. We examined interventions for 3 children with severe disabilities following inconclusive functional analyses. First, preferred stimuli were identified for each child via a stimulus preference assessment. Second, a functional analysis was conducted for 2 of the 3 children. High rates of aberrant behavior were seen even (if not especially) in no-interaction sessions. The 3rd child was observed for several consecutive no-interaction sessions; behavior persisted in this condition. Third, interventions based on environmental enrichment were analyzed in an analogue setting. For all of the children, environmental enrichment decreased aberrant behavior if preferred stimuli were used in the procedure. To obtain further reductions in aberrant behavior, explicit reinforcement of toy play was required for 2 children, and a brief (5-s) time-out was necessary with 1 child. Finally, effects of treatment carried over to the school or home environment following teacher or family training. Results are discussed in the context of basic reinforcement principles and future directions for research.     

Anxiety management training in the treatment of essential hypertension

The study was conducted to assess the efficacy of Anxiety Management Training as an adjunctive treatment for essential hypertension. Twenty-one patients with essential hypertension, all but one of whom were on antihypertension medication, were randomly assigned either to an Anxiety Management Training condition or a waiting-list control condition. At the time of a posttest assessment session, compared to subjects in the control condition, subjects in the Anxiety Management Training condition manifested a decrease in resting systolic and diastolic blood pressure and a decrease in systolic and diastolic blood pressure following a stressful task. At the time of a follow-up assessment session, subjects in the Anxiety Management Training condition not only manifested good maintenance of reduced blood pressure but also exhibited a further decrease in resting systolic blood pressure and a decrease in systolic blood pressure during the stressful task.     

Classification training in two- and three-year-old children

Two- and three-year-olds who did not group a set of geometric stimuli according to complete similarity on a pretest were divided into three experimental conditions: (a) a modeling condition in which the subjects observed a model group according to complete similarity while verbalizing his strategy, (b) a reinforcement condition in which the subjects were reinforced for sorting similar stimuli into boxes, and (c) a control condition. After the training sessions the Ss were given two posttests—one with stimuli identical to those used during the training session and one with a different set of geometric stimuli. On the posttests significantly more similarity classifications were obtained in the modeling condition than in either the reinforcement or the control conditions, which did not differ. It was concluded (a) that two- and three-year-olds can learn to group according to similarity, and (b) that modeling with verbalization is a very effective method for teaching young children to classify according to similarity.     

The effects of antecedent interventions and extinction on toddlers' compliance during transitions

We compared the effects of two antecedent strategies commonly used in early childhood settings to increase compliance during activity transitions: a warning condition, in which children were informed of the transition 2 min before it began, and a condition in which children were allowed access to a toy during the transition. Both antecedent interventions were ineffective when implemented alone; however, when these strategies were combined with extinction, improvements in compliance were observed for all children.