CLINICAL BEHAVIORAL PHARMACOLOGY: METHODS FOR EVALUATING MEDICATIONS AND CONTINGENCY MANAGEMENT

We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance.     

SERIOUS DELINQUENT BEHAVIOR AS PART OF A SIGNIFICANTLY HANDICAPPING CONDITION: CURES AND SUPPORTIVE ENVIRONMENTS

The past 20 years have been productive ones for the field of applied behavior analysis. A brief review of our own efforts during this period reveals that we have accomplished several but not all of our goals for the Teaching-Family approach. In this context, we note that the setting of realistic and appropriate goals is important for the field and for society. Moreover, we suggest that the realistic goal for some persons with serious delinquent behavior may be extended supportive and socializing treatment rather than permanent cure from conventional short-term treatment programs. We base this suggestion on the accumulating evidence that serious delinquent behavior may often be part of a significantly disabling and durable condition that consists of multiple antisocial and dysfunctional behaviors, often runs in families, and robustly eludes effective short-term treatment. Like other significant disabilities such as retardation, autism, and blindness, the effects of this condition may be a function of an interaction of environmental and constitutional variables. We argue that our field has the wherewithal to construct effective and humane long-term supportive environments for seriously delinquent youths. In this regard, we explore the dimensions, rationales, logistics, and beginnings of a new treatment direction that involves long-term supportive family treatment. We contend that such supportive families may be able to provide long, perhaps even lifetime, socializing influences through models, values, and contingencies that seem essential for developing and maintaining prosocial behavior in these high-risk youths.     

A structural model for postpartum responses to the somatic and cognitive items on the Beck Depression Inventory

A distinction can be drawn between those items on the Beck Depression Inventory (BDI) that reflect mainly cognitive and emotional symptoms and those that reflect somatic symptoms. Responses to the BDI were obtained from women at 3, 6, 9, and 24 weeks postpartum. The covariances of cognitive and somatic symptom scores across the four time points were closely fit by a structural equations model referred to as the simplex. The modeling indicates that earlier cognitive scores directly predict later somatic scores but that early somatic scores do not directly predict later cognitive scores. Other data confirm the results.Much of this research was supported while the first author was an NIMH Fellow at the University of Iowa (MH15168).     

Superimposition of response-independent reinforcement

Studies that have superimposed response-independent reinforcement (or reinforcers scheduled by contingencies placed on the absence of responding) upon conventional response-dependent schedules are reviewed. In general, providing alternative sources of reinforcement reduced response rates below the levels observed when alternative reinforcement was absent. However, response-rate elevation was sometimes found, particularly when rates of superimposed response-independent reinforcement were low. Superimposition of schedules providing reinforcers contingent on the absence of responding usually produced more severe response-rate decrements than superimposition of response-independent reinforcement. A variant of Herrnstein's equation, which assumes that some of the alternative reinforcers function as if they were delivered by baseline response-dependent source of reinforcement, is in qualitative agreement with the overall body of results obtained, and can predict both increases and decreases in response rate as resulting from superimposed reinforcers.     

A taxonomy of item response models

A number of models for categorical item response data have been proposed in recent years. The models appear to be quite different. However, they may usefully be organized as members of only three distinct classes, within which the models are distinguished only by assumptions and constraints on their parameters. “Difference models” are appropriate for ordered responses, “divide-by-total” models may be used for either ordered or nominal responses, and “left-side added” models are used for multiple-choice responses with guessing. The details of the taxonomy and the models are described in this paper. The present study was supported in part by two postdoctoral fellowships awarded to Lynne Steinberg: an Educational Testing Service Postdoctoral Fellowship at ETS, Princeton, NJ and an NIMH Individual National Research Service Award at Stanford University, Stanford, CA. Helpful comments by the editor and three anonymous reviewers are gratefully acknowledged.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

In-session gaming as a tool in treating adolescent problematic gaming

For some adolescent gamers, playing online games may become problematic, impairing functioning in personal, family, and other life domains. Parental and family factors are known to influence the odds that adolescents may develop problematic gaming (PG), negative parenting and conflictual family dynamics increasing the risk, whereas positive parenting and developmentally supportive family dynamics protecting against PG. This suggests that a treatment for adolescent PG should not only address the gaming behaviors and personal characteristics of the youth, but also the parental and family domains. An established research-supported treatment meeting these requirements is multidimensional family therapy (MDFT), which we adapted for use as adolescent PG treatment. We report here on one adaptation, applying in-session gaming. In-session demonstration of the “problem behavior” is feasible and informative in PG. In the opening stage of therapy, we use in-session gaming to establish an alliance between the therapist and the youth. By inviting them to play games, the therapist demonstrates that they are taken seriously, thus boosting treatment motivation. Later in treatment, gaming is introduced in family sessions, offering useful opportunities to intervene in family members' perspectives and interactional patterns revealed in vivo as the youth plays the game. These sessions can trigger strong emotions and reactions from the parents and youth and give rise to maladaptive transactions between the family members, thus offering ways to facilitate new discussions and experiences of each other. The insights gained from the game demonstration sessions aid the therapeutic process, more so than mere discussion about gaming.     

Longitudinal relations among perceived parental warmth,self-esteem and social behaviours from middle childhood to early adolescence in China: Disentangling between- and within-person associations

Although several studies have addressed the relations between perceived parental warmth and social behaviours, few have distinguished their between- and within-person effects or explored their within-person mediating mechanisms. This study examined the transactional relations among perceived parental warmth (i.e. maternal warmth and paternal warmth), children's self-esteem and children's positive/negative social behaviours (i.e. prosocial behaviour and delinquent behaviour) along with the mediating role of self-esteem after disentangling between- and within-person effects. A total of 4315 Chinese elementary children (44.9% girls; M_age = 9.93 years, SD = 0.73) completed relevant measures on four occasions employing 6-month intervals. Results of random-intercept cross-lagged panel models showed that (a) perceived parental warmth reciprocally and positively predicted prosocial behaviour and self-esteem; (b) perceived paternal warmth reciprocally and negatively predicted delinquent behaviour; (c) self-esteem reciprocally predicted prosocial and delinquent behaviour; (d) perceived maternal warmth reciprocally and positively predicted prosocial behaviour through self-esteem; (e) perceived parental warmth reciprocally and negatively predicted delinquent behaviour through self-esteem; and (f) perceived maternal and paternal warmth differed in their relations with prosocial and delinquent behaviours through self-esteem. These findings illuminated the complicated longitudinal within-person interactions among perceived parental warmth, self-esteem, and social behaviours, the specific mediating mechanism of self-esteem, and the differing results associated with perceived maternal and paternal warmth, all of which yield significant implications for assessments and early interventions aimed to promote positive social behaviour.     

Interobserver agreement and procedural fidelity: An odd asymmetry

We examined articles with experiments published in the Journal of Applied Behavior Analysis and in Behavior Analysis in Practice from 2017 through 2021 to determine how frequently procedural fidelity was assessed. When procedural fidelity was assessed, we determined how often a measure of interobserver agreement for those fidelity data was provided. We also determined how often a measure of interobserver agreement for participants' behavior was provided. Across both journals and all years, 54.7% of relevant articles provided a measure of procedural fidelity. Of them, 17.7% provided a measure of interobserver agreement for procedural fidelity. In marked contrast, 96.4% provided interobserver agreement data for participants' behavior. It is unfortunate that applied behavior analysts frequently fail to provide procedural fidelity data and, when they do, often fail to provide interobserver agreement data for the fidelity data. Reviewers for, and editors of, behavior-analytic journals are encouraged to strongly consider the relative value of procedural fidelity and agreement on procedural fidelity measures when rendering recommendations on the suitability of a given submission.