Applying the least restrictive alternative principle to treatment decisions: A legal and behavioral analysis

The least restrictive alternative concept is widely used in mental health law. This paper addresses how the concept has been applied to treatment decisions. The paper offers both a legal and a behavioral analysis to some problems that have emerged in recent years concerning the selection of behavioral procedures used to change client behavior. The paper also offers ways of improving the application of the concept, which involve developing a more behaviorally functional perspective toward restrictiveness.     

Child and adolescent psychopathology research: Problems and prospects for the 1990s

In November 1990 the National Institute of Mental Health (NIMH) convened a special conference of over 100 scientists and leaders to outline specific strategies and research initiatives that should be developed to implement the recently released National Plan for Research on Child and Adolescent Mental Disorders.Participants included journal editors, educators from psychology and psychiatry, representatives from private foundations, and leaders of research program areas in public funding agencies. Critical knowledge gaps were identified in five areas of child and adolescent psychopathology, including depression, attention deficit hyperactivity disorder, conduct disorder, the anxiety disorders, and the developmental disorders. For each of these areas, special emphasis was placed on developing new ideas and obtaining critical input from other areas of investigation. This report summarizes the identified research gaps and recommends research initiatives to implement the National Plan, as outlined by the conference participants.     

A Legacy of Silence: Bioethics and the Culture of Pain

For over 20 years the medical literature has carefully documented the undertreatment of all types of pain by physicians. During this same period, as the field of bioethics came of age, the phenomenon of undertreated pain received almost no attention from the bioethics literature. This article takes bioethicists to task for failing to recognize the undertreatment of pain as a major ethical, and not merely a clinical, failing of the medical profession. The nature and extent of the problem of undertreated pain is examined, as well as possible reasons for its disregard by bioethicists. The factors contributing to undertreated pain in the clinical setting are considered, as well as the hazards posed by recent failures to address ethically questionable clinical practices. Finally, suggestions are offered for refocusing the attention of bioethicists to this significant problem.     

Deterrence, Opportunity, and Choice

Traditional studies of deterrence have focused on punishment with less regard for the rewards of both crime and noncrime. Influenced by work in economics and behavioral psychology, more recent studies have departed from tradition by incorporating rewards for crime. To this extent, they should be regarded as advances over the more traditional approaches. Notwithstanding these advances, variations in both the probability and magnitude of reward for noncrime have not been systematically included in these more recent theories of choice. In an attempt to determine whether opportunities for noncrime are either central or trivial to the criminal decision-making process, the present study fitted two alternative models to experimental data involving risk-taking: (a) the economic utility model employed by Piliavin, Gartner, Thornton, and Matsueda (1986) in their study of criminal choice; and (b) the satisfaction balance model developed by Gray and Tallman (1984). Results showed that while both models explained significant amounts of variation in the dependent variable, the Gray-Tallman model provided a substantially better fit of the data. Despite limitations inherent in experimental studies as, for example, limitations surrounding the issue of external validity, the findings strongly suggest that opportunities for noncrime are as important as rewards and costs for crime in the process by which criminal decisions are made.     

Parental Smoking and the “Epidemic” Spread of Cigarette Smoking1

“Epidemic” models of transitions between stages of cigarette smoking describe the spread of smoking behavior through face-to-face encounters. An epidemic model was successfully fitted that allowed epidemic parameters to be conditioned on the smoking status of adolescents' parents. Model comparisons supported the conclusion that the transition from nonsmoker to trier involved social contacts, whereas the transition from trier to regular smoker was best modeled as a constant rate (i.e., did not depend on the population prevalence of smokers). The transition rate from nonsmoker to trier was more rapid in children of smoking parents than in children of nonsmoking parents. Adolescents with and without smoking parents did not differ in the rate of transition from trier to regular smoking.     

Evidence that blocking is due to associative deficit: Blocking history affects the degree of subsequent associative competition

Rats were trained on an appetitive discriminated operant procedure according to a blocking design, in which training with a compound stimulus (A + B) was given with or without prior training with A alone. Stimulus B was then presented in compound with a new stimulus (B + C compound). The ability of Stimulus B to block acquisition of control by Stimulus C was decreased by B having itself been blocked by A during the prior training. The results imply that the mechanism of blocking during the initial blocking procedure was a reduced association between Stimulus B and the reinforcer, and not a performance deficit such as that postulated by comparator models of learning.