The Behavioral and Emotional Rating Scale: Test-Retest and Inter-Rater Reliability

Two studies are reported addressing the reliability of the Behavioral and Emotional Rating Scale (BERS). The first study investigated test-retest reliability over a two-week period to determine the stability of the measure over time. The second study investigated inter-rater reliability between two teachers or classroom aides who were familiar with a student to determine the consistency with which the measure can be used by different individuals. In each study, samples were drawn from populations of students identified with emotional or behavioral disorders as specified by federal statutes. Reliability coefficients in each study were above .80, the standard recommended for screening tests that are reported individually, and in most cases above .90. Implications for use of the BERS are discussed.     

Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.     

视空间定位的短时记忆的超广度研究

采用视空间定位的短时记忆任务研究记忆负载的增加对空间位置信息和时间顺序信息的记忆成绩的影响。结果表明,在记忆负载较低时,位置记忆和顺序记忆的成绩相同;当记忆负载逐渐增大时,位置记忆的成绩逐渐上升,而顺序记忆的成绩先上升后下降,两者出现显著性的差异。在这个过程中,短时记忆的加工发生相应的变化,体现了短时记忆加工资源的有限性。     

An Integrative Brief Treatment Approach for Obsessive-Compulsive Disorder

This article reports on the integrated application of cognitive therapy, transactional analysis techniques, and the behavioral technique of response prevention using self-instructional training and behavioral substitution in a brief therapy approach. These methods were applied in the case of a young man who presented with compulsions to perform repetitive and ordering rituals with the belief that it would prevent his girlfriend from becoming pregnant. A 21-year-old white male who had performed 3 to 5 hours of rituals daily for several years was able to eliminate the majority of his compulsive behaviors and reduce his level of anxiety after eight clinical therapy sessions. Results were maintained at 6-month follow-up. The clear precipitating factors and the unusual maintaining variables for the disorder in the client are described. The author discusses the case in light of current theoretical, therapeutic, and biomedical understandings of the disorder.     

Moral Responses and Moral Theory: Socially-based Externalist Ethics

The paper outlines a view called social (or two-level) response-dependency as an addition to standard alternatives in metaethics that allows for a position intermediate between standard versions of internalism and externalism on the question of motivational force. Instead of taking psychological responses as either directly supplying the content of ethics (as on emotivist or sentimentalist accounts) or as irrelevant to its content (as in classical versions of Kantian or utilitarian ethics), the view allows them an indirect role, as motivational props to moral teaching and thus to the general institution of moral discourse. However, they are not implied by any particular moral judgment (or speaker), so that amoralism comes out as possible. The response that defines the distinctively moral notion of wrong on this account is the second-level (social) response of forbidding some behavior; but this is ultimately to be understood in terms of (variable) individual reactions. Natural human emotion tendencies thereby constrain the content of ethics, while allowing for some degree of social variation in moral codes.     

STIMULUS FADING AS TREATMENT FOR OBSCENITY IN A BRAIN-INJURED ADULT

Obscene verbalizations of a person with traumatic brain injury were treated using stimulus fading as the singular form of intervention. Results of a functional assessment revealed that obscenity was maintained by negative reinforcement. Stimulus fading (initial elimination of instructional demands followed by their gradual reintroduction) produced immediate and substantial reductions in obscenity that were maintained as the frequency of demands increased to baseline levels. Potential applications of the use of antecedent treatment strategies are discussed.     

REEMERGENCE AND EXTINCTION OF SELF-INJURIOUS ESCAPE BEHAVIOR DURING STIMULUS (INSTRUCTIONAL) FADING

Based on results of a functional analysis indicating that the self-injurious behavior (SIB) of 3 individuals was maintained by negative reinforcement (escape from instructional situations), the effects of stimulus (instructional) fading were evaluated in a multiple baseline design across subjects. The rate of instructions was reduced to zero at the beginning of treatment and was gradually increased (faded in) across sessions as long as SIB remained low. However, if SIB remained high for 10 consecutive sessions, extinction was implemented until SIB decreased, at which point extinction was withdrawn and fading was resumed. Treatment was completed when the rate of instructions was the same as in baseline (two per minute), and SIB remained below 0.5 responses per minute for two consecutive sessions. Results showed that instructional fading (without extinction) virtually eliminated SIB initially, but these effects were not maintained. All 3 subjects required multiple exposures to extinction and over 150 treatment sessions in order to meet the end-of-treatment criteria. Advantages and limitations of fading procedures without an extinction component, as well as extensions of both interventions to other clinical problems, are discussed.