The pain behavior scale: Modification and validation for outpatient use

The present study investigated the validity of an inpatient pain behavior rating scale modified for outpatient use. A series of 43 consecutive outpatients referred for evaluation of chronic pain was examined using the Pain Behavior Scale (PBS) and other psychometric instruments. Analyses revealed significantly higher Pain Behavior Scale scores for low back and multiple pain-site groups. The results also indicated a high degree of internal consistency of the scale. A multiple regression analysis, predicting observed pain behavior from reported pain behavior, indicated that decreased activity accounted for 32% of the variance in the PBS score. A similar regression for pain experience found that the pain level and the sensory scale score on the McGill Pain Questionnaire accounted for 39% of the PBS variance. Psychological characteristics including disease conviction, self-control, depression, and anxiety explained 45% of the variability in the PBS score. Thus, the scale is related to pain intensity, interference with activities, and a variety of psychological characteristics. The scale provides a measure of observable pain behavior that is also relatively independent of these clinical data sources. The Pain Behavior Scale as modified for outpatient use provides a brief index of pain behavior with potential use in the comprehensive evaluation of the pain patient.     

The effect of sex differences on sociometric data generated by a roster-rating scale instrument

Sociometric data generated by roster-rating scale instruments are being used for assessment and evaluation purposes. Little information exists, however, on the influence of peer gender on this particular type of sociometric data. In a sample of 441 male and 455 female fourth, fifth, and sixth grade children, this study found same-sex ratings to be significantly higher than opposite-sex ratings. Opposite-sex ratings, while significantly lower, were slightly correlated with the higher same-sex ratings. Differing methods for interpreting roster-rating scale data are discussed in light of the above results.The author is Assistant Professor at the School of Social Welfare, State University of New York at Albany currently on leave at the Baerwald School of Social Work, Hebrew University, Jerusalem, Israel. This project was completed under the auspices of the Interpersonal Skill Training and Research Project of the School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin.     

Naturalistic observations of pathological behavior in hospitalized psychiatric patients

Naturalistic observations were conducted on 19 acutely ill psychiatric patients in the hospital ward milieu. The study was designed to determine relationships between selected social and environment variables and overt atypical behavior. Patients were observed on an individual basis with time-sampling techniques. In total, 16 pathological behaviors were coded and the most frequent (postural deviance, pace, agitation, hyperactivity, withdrawal, foot shake/body sway, leg swing) were selected in order to determine variation in frequency of these behaviors as a function of the following variables: area within hospital, week of hospitalization, distance between the focal subject and his/her nearest neighbor, number of people in an area, and time of day. Results showed differential changes in pathological behavior as a function of week of hospitalization, number of people in a given area, and distance from the focal subject's nearest neighbor. There was no significant change in the frequency of pathological behaviors as a function of area within hospital or time of day. In addition, most pathological behaviors decreased significantly when patients were engaged in the sending or receiving of verbal behavior. Cluster analyses revealed varying degrees of dissociation between pathological behaviors and social-interaction behaviors. These results support (a) a nonunitary concept of the general category pathological and (b) the view that there are inhibitory effects of social interaction on the enactment of atypical behaviors. Clinical implications of these findings are discussed.R.H.P. completed this research during his tenure as a postdoctocal fellow in the Department of Psychiatry, Human Ethology Laboratory, UCLA (NIMH Fellowship 1 F32MHO7627-01). Support for this research also came from the Veterans Administration.     

Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.     

FUNCTIONAL ASSESSMENT,CURRICULAR REVISION,AND SEVERE BEHAVIOR PROBLEMS

An adolescent female with multiple handicaps and a long history of severely disruptive behavior participated in a functional assessment linked directly to specific revisions in her school curriculum. During Phase 1, reversal designs were used to test hypotheses pertaining to antecedent and auricular influences on problem behavior. During Phase 2, a multiple baseline across afternoon and morning time periods demonstrated that the auricular revisions were effective in eliminating severely disruptive behavior and increasing on-task responding. Data also showed that inappropriate “psychotic” speech was reduced and appropriate social interactions were increased. Follow-up results showed that the changes were maintained throughout the school year. Questionnaire data provided social validation of the procedures and outcomes. The findings are discussed in relation to their implications for functional assessment, individualized curricula, and positive programming for students with disabilities and serious behavior problems.     

A COMPREHENSIVE EVALUATION OF REINFORCER IDENTIFICATION PROCESSES FOR PERSONS WITH PROFOUND MULTIPLE HANDICAPS

We evaluated comprehensively a preference assessment for identifying reinforcers for persons with profound multiple handicaps. Four experiments were conducted involving 18 individuals. Results of Experiment 1 replicated previous findings in that the assessment identified student preferences for respective stimuli, and caregiver opinion of preferences did not coincide with the systematic assessment. Results of Experiment 2 indicated highly preferred stimuli were likely to function as reinforcers in training programs, whereas stimuli not highly preferred did not function as reinforcers. Results of Experiment 3 suggested the 12 stimuli used in the assessment represented a comprehensive stimulus set for identifying preferences, although the utility of the set sometimes could be enhanced by caregiver opinion. Results of Experiment 4 indicated the assessment identified preferences likely to be maintained over time. Overall, results are discussed in terms of identifying limits and alternatives to a behavioral teaching technology when applied to persons with profound multiple handicaps.     

Teachers' and mothers' assessment of children's behaviors from kindergarten to grade two: Stability and change within and across informants

Consistency between teachers' and parents' ratings of 229 children's prosocial and problem behaviors was investigated from kindergarten through grade two. Intrarater stability was also analyzed. Results indicated moderate but decreasing interrater agreement from kindergarten to grade two for boys on externalizing behaviors. Interrater agreement for the same behavior dimension for girls was moderate and stable, whereas it was low on internalizing behavior problems and prosocial behaviors, for both genders throughout the 3-year period. Moreover, difference between teachers' and parents' ratings of externalizing behaviors increased from kindergarten to grade two. Decreasing level of agreement through time appeared to be related to a reduction of teacher-rated externalizing behaviors not paralleled by a reduction in parent ratings. Analyses were also performed at the item level of the externalization scale to identify which specific behaviors were responsible for the increasing divergence in interrater agreement from kindergarten through grade two. Alternative interpretations were considered in order to account for present and past results. Implications for screening and assessment purposes were discussed.This research was supported by grants from the Social Sciences and Humanities Research Council of Canada and from Québec's Health Research Fund (FRSQ). We wish to thank the authorities and directors of the schools from the Val d'Or School Board as well as the kindergarten, first and second grade teachers, children, and parents for their collaboration. We also thank Lyse Desmarais-Gervais, Daniel Corriveau, Jean Desrosiers and Hélène Boileau for their participation in the data collection or analysis.     

The role of the psychologist expert witness: Provider of perspective and input

The definition and role of the expert witness is reviewed. Two conceptual systems for viewing the world, the scientific method and the adversarial system, are compared. The reconciliation and integration of these two discrepant systems are discussed in terms of input versus outcome. The rules of evidence, as well as problems of communication between the systems, are reviewed with the aim of providing expert witnesses with a better understanding of effective testimony. Finally, collaboration between the two systems is called for in order to provide guidelines for both neuropsychologists and attorneys.     

Teaching minority high school students to recruit helpers to attain personal and educational goals

Recruiting help from mentors and other potential helpers is a promising strategy for helping disadvantaged and minority youths meet their personal and educational goals. Three African-American high school seniors participated in a project designed to evaluate the effectiveness of training procedures that would allow them to ask for help in attaining educational and other personal goals. A behavioral training procedure that included instructional materials, role-play practice, praise, and feedback was used. Targeted skills included goal setting and 30 responses involved in the process of meeting with a potential helper. Role-play situations were used to evaluate participants' help-recruiting skills before and after training. Participants increased their help-recruiting skills from an average of 38% during baseline, to an average of 75% after training. Self-reported measures of goal attainment suggested that the students benefited from the training. Implications for mentoring programs designed to increase minority students' opportunities to reach educational goals were discussed.     

The Assertive Interaction Coding System

Conceptual and theoretical issues concerning the assessment of assertive behavior are discussed. A summary of a variety of instruments utilized in experimental and clinical settings is offered that reflects these issues. This review is followed by the presentation of a new assessment device developed by the authors—the Assertive Interaction Coding System. Research evidence as to its reliability and validity in experimental and clinical settings is presented. Implications for its use in clinical and research protocols are addressed.