Teaching self-treatment of cold symptoms to an anoxic brain injured adult

Traumatic brain injury can result in behavioral and physical deficits that require intensive post-acute residential rehabilitation. Behaviors targeted by such programs include basic self-care and living skills. We examined the efficacy of a behavioral training strategy to teach appropriate medical treatment of four different groups of simulated cold symptoms to an anoxic brain injured adult. The strategy included instructor prompting and feedback in the use of written task analyses and picture cues as self-administered prompts. Subsequent to baseline, the participant used written generic task analyses combined with picture cues and then, if necessary, written specific task analyses combined with picture cues to prompt appropriate self-treatment of the four types of colds. Written individualized task analyses, tailored to participant errors, were used to fade specific task analysis prompts and transfer stimulus control to the discriminative stimuli present in the picture cues. A multiple baseline design across responses showed that skill acquisition did not occur after generic task analysis training, but did so after specific task analysis training. The participant responded to all four types of colds for three consecutive trials at 100% correct under baseline conditions. Follow-up results indicated that transfer of stimulus control to the cold symptoms simulated by the picture cues alone did not maintain over time. Correct responding was retrained using generic and, if necessary, individualized task analysis training conditions.     

Conversational skills for autistic adolescents: An autistic peer as prompter

In this study, an autistic youth served as peer prompter for three other autistic adolescents. The peer prompter encouraged the other boys to talk about sports, a topic frequently discussed by typical teenagers. A multiple-baseline design across participants was used to assess the effectiveness of the peer-prompting procedure. During baseline, the youth rarely talked about sports, although all three had previously completed a sports-appreciation class and had displayed large pre-to-post gains on a paper-and-pencil test. During intervention, when a peer prompted sports discussions, all three youth engaged in much more sports-related conversation. Generalization measures indicated that: (1) the youth engaged in sports discussions in groups, as well as in the dyads that characterized the training situation; (2) they talked about sports in a setting other than the training setting; (3) they discussed sports with their peers when an unfamiliar teacher was present; and (4) they continued to discuss sports when training tapes and behavioral contracts between the teacher and the peer prompter were withdrawn. Previously, it has been common to use nonhandicapped or less-handicapped peers as tutors; this study demonstrates that an autistic youth may also effectively serve as a prompter who assists his schoolmates in acquiring conversational skills that contribute to their normalization.     

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Anxiety in adolescence and its significance for psychoanalysis

The theme of this paper is the well-known resistance of adolescents to participate in analytic treatment and analysts' reservations about treating adolescents, which is perhaps less well known. Several reasons are discussed: For adolescents, the revival of separational and fusional anxieties during the process of individuation as well as resistance to the analytic setting are held responsible; analysts may lack sufficient awareness of their own adolescence and its resulting anxieties to be able to confront this developmental period. In addition, there are countertransference anxieties that are triggered and kept alive by the behavior of the juvenile patient. The different types of analyst anxieties as well as those of the adolescent under analysis are explained and their significance in the process of individuation and the course of therapy is noted.     

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

Reducing smoking among pregnant adolescents

Pregnant adolescents who smoke present a double obstetrical risk. Not only is the adolescent mother at risk from the biological, social, educational, and economic factors associated with childbearing at a young age, she and her developing infant also risk the complications associated with maternal smoking. This paper describes a psychosocial intervention designed to reduce smoking in a group of pregnant adolescents. Five modules are presented. Each is designed to: (1) heighten awareness of the issue, (2) provide motivational messages, (3) enhance the adolescent's social skills, and (4) teach specific smoking-cessation skills.     

Occult participation: its impact on adolescent development

This study investigated the relationship between occult participation, substance abuse, and level of self-esteem in adolescents. Data were collected from 50 adolescents who ranged in age from 12 to 19 years and who spoke English as their primary language. The combined group of adolescents consisted of 25 clinical and 25 nonclinical youth. Participants completed a three-part questionnaire package which included Rosenberg's Self-Esteem Scale, the Adolescent Magic Questionnaire, and the Drug and Alcohol Assessment Scale. Results indicated that adolescent substance abuse and occult participation were significantly related. High and low occult participation groups were determined, and significant differences were found between the high versus low occult groups when compared on the primary variables of self-esteem and substance abuse. Significant differences were also noted when comparing the high versus low occult groups with various psychosocial developmental variables. Included is a discussion of the impact of occult participation on the psychosocial elements of adolescent self-esteem, self-concept, tolerance for deviance, and religious involvement.     

Emotional disturbance and the development of self-consciousness in adolescence

The development of self-consciousness and its relationship to emotional disturbance was examined in early and late adolescence. The Imaginary Audience Scale was administered to emotionally disturbed and nondisturbed adolescents. As predicted, results indicated that self-consciousness decreased with age in nondisturbed adolescents. For the emotionally disturbed adolescents, the development of self-consciousness in temporary situations did not follow consistent patterns, as indicated by interaction effects. A significant negative relationship was found between intelligence test scores and self-consciousness in the disturbed group. The findings support the premise that social-cognitive shifts found in early to late adolescence are disrupted in disturbed populations. The mediating role of social experience as a factor in cognitive and emotional development is discussed.