Treatment of Young Children's Bedtime Refusal and Nighttime Wakings: A Comparison of “Standard” and Graduated Ignoring Procedures

Young children with sleep problems received either standard or graduated ignoring treatment. Both brief treatments were superior to a wait-list control condition and resulted in comparable improvements in bedtime and nighttime sleep problems. At bedtime, the treatments did not differ with respect to maternal compliance and stress. For nighttime wakings, mothers in the graduated ignoring group reported higher rates of compliance and less treatment-related stress. Maternal characteristics predicted treatment outcome in the standard ignoring condition. Following treatment, only positive side effects were observed. When compared to the wait-list group, mothers in the standard ignoring group reported less verbose discipline and decreased stress in parenting, while mothers in the graduated ignoring group reported improved parent–child relationships. Treatment gains were maintained over a 2-month follow-up period.     

Analysis of public verbal feedback as a staff management procedure

We evaluated public verbal feedback as a potentially effective and efficient means of improving institutional staff performance. Following baseline observations of the self-help training conducted by three groups of direct care staff with clients who had profound mental retardation, verbal feedback was presented publicly to individual staff during routine staff meetings. The feedback addressed the (in)frequency of the staffs training endeavors and required only a few minutes to present. Results indicated that each group of staff increased their client training when the public verbal feedback was provided. Probes of client self-help skills indicated that as the frequency of staff-conducted training increased, client skill acquisition improved. Generalization measures indicated that staff increased only those work behaviors for which they received feedback. Results are discussed regarding the efficiency of public verbal feedback as a means of improving staff performance, as well as the need for research to continue expanding and refining a technology of staff management.     

EVALUATION OF COMPONENTS OF RESIDENTIAL TREATMENT BY MEDICAID ICF-MR SURVEYS: A VALIDITY ASSESSMENT

We evaluated the proficiency of the federal Medicaid program's survey process for evaluating intermediate care facilities for the mentally retarded. In Study 1, an observational analysis of active treatment during leisure times in living units suggested that these surveys did not discriminate between certified and noncertified units. In Study 2, a reactivity analysis of a survey indicated that direct-care staff performed differently during the survey by increasing interactions with clients and decreasing nonwork behavior. Similarly, results of Study 3 showed increases in client access to leisure materials during a survey. In Study 4, questionnaire results indicated considerable variability among service providers' opinions on the consistency, accuracy, and objectivity with which survey teams determine agency standard compliance. Results are discussed regarding effects of the questionable proficiency of survey processes and the potential utility of behavioral assessment methodologies to improve such processes.     

INCREASING HABILITATIVE SERVICES FOR PERSONS WITH PROFOUND HANDICAPS: AN APPLICATION OF STRUCTURAL ANALYSIS TO STAFF MANAGEMENT

We evaluated a structural analysis methodology for enhancing the utility of a staff management program. In Experiment 1, a structural analysis of direct-care staff behavior in a mental retardation facility revealed differences in work patterns over time. Specific times were identified when few basic care duties were necessary and staff engaged in nonwork activity. In Experiment 2, a management program was implemented to increase staff members' training activities during periods identified through the structural analysis. The program was accompanied by increases in training activities and decreases in nonwork behavior. The improvements were maintained during a 43-week period while the most labor-intensive component of the program was withdrawn. Staff acceptability measures indicated a positive response to the management intervention, although responses varied across components within the multifaceted program. The increased training was accompanied by beneficial changes among clients with profound handicaps. Results are discussed regarding practical considerations for improving staff performance and for adopting innovations resulting from applied research.     

Mediational screening as a model for prevention research

Examined here is Pillow, Sandler, Braver, Wolchik, and Gersten's (this issue) strategy for screening prevention trial participants. The reviewer concludes that their selection strategy should increase the statistical power of prevention outcome studies, increase intervention cost effectiveness, and help to prevent their possible iatrogenic effects. Also, their model points up inadequacies in the longitudinal data on which most prevention strategies are based, and their model could well serve as a template for future research.     

Individuation and reference in memory: Proper names and definite descriptions

A theory is presented which assumes that individuals are represented by unique nodes in memory. To test the theory, simple facts were predicated of an individual person. Some facts referred to him by proper name, and other facts by his profession. In a before condition, subjects learned that the profession and name referred to the same individual before learning the facts, while in an after condition, they learned the identity after learning the facts. Subsequent to learning the facts and identities, subjects verified sentences based on what they had learned. Verification latencies indicated that in the before condition, one memory node was created to represent the individual, but two nodes were set up in the after condition. Assymmetries between proper names and professions indicate that the two types of referring expressions are treated differently in long-term memory.     

Sound-induced seizure: asymmetries exhibited are related to the latency of seizure onset

Audiogenic seizures of SJL/J mice sensitized before 3 weeks of age were found to be of two distinct types. Seizures with short latencies to onset were without clear asymmetries of either run or fall direction, whereas seizures occurring after a longer latency were characterized by asymmetries of both of these behaviors.     

Group instruction with profoundly retarded persons: acquisition, generalization, and maintenance of a remunerative work skill.

We evaluated a group instruction program for teaching a vocational skill to profoundly retarded adults. The program involved designated trainer roles and both individual student-directed and total group-directed procedures. Results indicated that, following the program, participants acquired the skill of stamping addresses on envelopes, the skill generalized across an untrained type of envelope, and the skill maintained over time. The group activity was incorporated into the regular classroom without increased disruption and the participants earned a wage for their productivity. Implications for the development of a group instruction technology for severely handicapped persons are discussed.