Optimizing Engagement in Behavioral Parent Training: Progress Toward a Technology-Enhanced Treatment Model

Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families’ engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.     

Providing noncontingent,alternative, functional reinforcers during delays following functional communication training

Functional Communication Training (FCT) involves arranging extinction for problem behavior and reinforcement for a more desirable, functionally equivalent, communicative response (FCR). Although effective under ideal arrangements, the introduction of delays to reinforcement following the FCR can result in increased problem behavior. Austin and Tiger (2015) showed that for individuals whose problem behavior was sensitive to multiple sources of reinforcement, providing access to alternative, functional reinforcers during delays mitigated this increase in problem behavior during delay fading. The current study replicated the procedures of Austin and Tiger with 2 individuals displaying multiply controlled problem behavior. Providing alternative functional reinforcers reduced problem behavior during 10-min delays for both participants without requiring delay fading.     

Stigma towards psychosis: Cross‐cultural differences in prejudice,stereotypes, and discrimination in White British and South Asians

Public stigma towards people with mental health problems has been demonstrated in Western societies. Little is known about non‐Western cultures and whether cultures differ in their perceptions of people with mental health problems. Aim of this study was to examine cultural differences in prejudice, stereotypes, and discrimination towards people with psychosis. Participants were from White British and South Asian backgrounds (N = 128, aged 16–20 years) recruited from two schools and colleges in the United Kingdom. They completed a cross‐sectional survey on affective, cognitive, and behavioural dimensions of stigma. Results revealed significant cultural differences on all three stigma dimensions. South Asians attributed higher anger (prejudice) and dangerousness (stereotypes) to people with psychosis than White British. They also reported lower willingness to help, greater avoidance, and higher endorsement of segregation (discrimination). The effects of ethnic group on helping intentions, avoidance, and segregation endorsement were mediated by anger and by dangerousness. Understanding cultural differences in stigma towards psychosis will be important for designing stigma interventions as well as treatments for people with different cultural backgrounds.     

Attachment and affect regulation: a framework for family treatment of conduct disorder

Conduct disorder (CD), a pervasive adolescent disorder with clinically significant antisocial behaviors, has been a difficult syndrome to treat successfully. Recently, research on affect regulation and attachment has suggested that attachment and affect regulation strategies may underlie the development of conduct disorder in adolescents, implying that attention to these factors might improve family treatment for CD. In this review of the research literature, I discuss the role of attachment and affect regulation in the development and treatment of CD. In addition, I present information about the framework, intervention protocol, and preliminary evidence of effectiveness of an attachment- and affect regulation-based intervention that has been developed and implemented with multiple-family groups of parents and incarcerated adolescents.     

Inhibition and superconditioning

Superconditioning is said to occur when learning an association between a conditioned stimulus (CS) and unconditioned stimulus (US) is facilitated by pairing the CS with the US in the presence of a previously established conditioned inhibitor. Previous demonstrations of superconditioning have been criticized because their control conditions have allowed alternative interpretations. Using a within–subjects autoshaping procedure, the present study unambiguously demonstrated superconditioning. The results support the view that superconditioning is the symmetric opposite of blocking.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Immunity to functional fixedness in young children

In thecandle problem (Duncker, 1945), subjects must attach a candle to a vertical surface, using only a box of tacks and a book of matches. Subjects exhibitfunctional fixedness by failing, or being slow, to make use of one object (the tack box) as a support, rather than as a container, in their solutions. This failure to produce alternate functions is measured against improved performance when the tack box is presented empty rather than full of tacks (i.e., not preutilized as a container). Using an analogous task, we show that functional fixedness can be demonstrated in older children (6- and 7-year-olds); they are significantly slower to use a box as a support when its containment function has been demonstrated than when it has not. However, younger children (5-year-olds) are immune to this effect, showing no advantage when the standard function is not demonstrated. Moreover, their performance under conditions of preutilization is better than that of both older groups. These results are interpreted in terms of children’s developing intuitions about function and the effects of past experience on problem solving.     

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.