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.     

Learning to argue with parents and peers

The infant's first natural response when faced with opposition or when he opposes others' actions is to cry. As this kind of behavior becomes ineffective, the responses of the individuals with which he interacts force him to adopt more conventional — especially verbal — patterns of arguing, leading him to rational argumentation. The purpose of the present paper is to observe progressions in children's earliest verbal arguments and to see how and when they learn to adjust their strategies for different kinds of opponents (peers; parents; other adults). In order to examine the emergence of such persuasive strategies, and their distribution according to the different categories of opponents, systematic audiotape recordings of two Spanish-speaking girls between 2 and 3 years were analyzed. The data suggest that, although there were some differences in how the girls argued with parents versus peers, they were only beginning to adjust their speech to make it appropriate for one or the other type of listener. In general, they resorted to one dominant strategy for all listeners (insist, repeat, cry, scream, ...). Each girl, however, developed a small number of less frequently used strategies that she reserved for a subcategory of opponents. For example, one of them, Nancy, only threatened and insulted peers, while the other, Marisa, only used please and a temporizing strategy with parents. The girls used less adaptive, more agressive strategies (e.g. threats and insults) with their peers. With one exception, all of the girls' moves were self-centered. In fact, the girls had not yet reached the stage of rational argumentation.     

The assessment of type a behavior in children and adolescents: An overview

The present article presents an overview of the instruments that have been used to assess the Type A behavior pattern in children and adolescents. The development, usage, and psychometric properties of each assessment technique are discussed, with methodological concerns being addressed whenever appropriate. The Matthews Youth Test for Health is the assessment of choice for children, because of its brevity, ease of administration, and adequate psychometric properties. The Hunter-Wolf A-B Rating Scale is desirable only for older, highly literate children. The Adolescent Structured Interview appears to be the most promising device for the adolescent age range. The other adolescent assessment devices are relatively unpopular, difficult to administer, and not always conceptually parallel to existing research on Type A behavior. Recommendations for future research are presented.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SEVERE PICA

A two-phase functional analysis of a profoundly retarded 19-year-old male's pica facilitated the design of an effective intervention containing no aversive components. In the first analysis, frequent staff-client interaction resulted in 25% and 66% less pica than limited and no interaction, respectively. Paradoxical effects were obtained in the second analysis, where no protective helmet resulted in 38% and 26% less pica than the helmet with face shield and helmet without face shield, respectively. On the basis of these analyses, limited interaction and no helmet conditions were combined in an effective, staff-implemented treatment at a medium-sized institution.     

Social and solipsistic observer training: Effects on agreement with a criterion

The need to train accurate, not necessarily agreeing, observers is discussed. Intraobserver consistency as an intermediate criterion in such training is proposed and contrasted with the more familiar criterion of interobserver agreement. Videotaped observations of social interactions between handicapped and nonhandicapped preschoolers provided the medium for examining the criterion agreement of four observers trained against each type of standard. Observers generally failed to show high levels of criterion agreement whether trained to a within- or to a between-observer agreement standard. The results varied somewhat with the frequency of behaviors, however. Correlations between interobserver agreement and intraobserver consistency were variable but somewhat higher when interobserver agreement was the training criterion than when intraobserver consistency was the criterion. Correlations between interobserver agreement and criterion agreement ranged from — .16 to .89 during interobserver agreement training. Correlations between intraobserver consistency and criterion agreement ranged from — .23 to .99 during intraobserver consistency training.     

Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

Conceptual,methodological, and clinical issues in the assessment of anxiety disorders

Many conceptual, methodological, and clinical issues remain unresolved in the assessment of anxiety disorders. Despite the prevalence, incidence, chronicity, and severity of anxiety disorders, research efforts and funding have fallen behind with regard both to other disorders and to addressing critical issues in the field. The primary objective of this paper is to provide a scientific critique regarding a number of often ignored yet salient considerations in anxiety-disorders assessment. Critical analyses of and recommendations regarding the multidimensional nature of anxiety, comorbidity, uniformity myths, synchrony, normative comparisons, psychometric properties of measures, and treatment integrity are offered. Finally, promising areas of clinical research are presented to enhance further the current understanding of the complexities inherent in assessing anxiety disorders.Preparation of this paper was supported in part by NIMH Grant MH36299.     

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.