THE USE OF PEER MONITORS TO REDUCE NEGATIVE INTERACTION DURING RECESS

The negative interactions of a mildly retarded child, Dennis, were reduced in three daily recess periods, withthe use of a point system. Adult monitors initiatedthe intervention inthe morning recess; reductions achieved during adult monitoring were maintained in that recess during two subsequent conditions: peer monitoring and self-monitoring. Dennis' negative interactions were reduced next inthe afternoon recess by peer monitors. Again, reductions were maintained during a subsequent self-monitoring condition. Finally, duringthe noon recess, Dennis was trained to serve as a peer monitor for Ed, a moderately retarded classmate. Dennis' rate of negative interactions quickly decreased following his appointment as a peer monitor. The results show that a point system, originally designed for adult monitoring, can be adapted without loss of program effectiveness for peer monitoring or self-monitoring. The results also suggest that classmates who serve as peer monitors may benefit significantly from their role. The conditions under which these therapeutic effects occur andthe role that treatment order effects may play in this process require further investigation.     

Changes in Cognitions, Emotions, and Behaviors in Depressed Patients and Their Spouses Following Marital Cognitive Therapy, Traditional Cognitive Therapy, Pharmacotherapy, and No Intervention

This study evaluated specific influences of a cognitive marital treatment (CMT) for depression based on an integration of cognitive theory of depression and systems theory. The effects of CMT on variables representing cognitions, emotions, and behaviors were compared with the effects of traditional cognitive therapy (CT), pharmacotherapy (PT), and no treatment (NT). Subjects were Major Depression Disorder and Dysthymic outpatients and their spouses. The changes considered were for pre–post treatment and pre-treatment–follow-up. CMT affected a wider range of variables than other treatments. In most instances it was also superior to the NT condition. Most of the gains were manifested at termination and lasted through follow-up. The variables affected by CMT were patients' and spouses' cognitions and emotions. PT had best effects on patients' emotions. CT affected patients' cognitions, but did not achieve superiority on any of the compared variables. None of the treatments produced significant changes in behaviors.     

Sexual Risk-Taking Behaviors Among Adolescents with Severe Emotional Disturbance

We investigated the sexual risk-taking behaviors of adolescents with severe emotional disturbance (SED). Subjects (N = 70) were clients of the South Carolina Continuum of Care. Information on sexual intercourse, sexual risk-taking, aggressive behaviors, substance use, and suicidal behavior was gathered using a modified version of the US Centers for Disease Control and Prevention self-report Youth Risk Behavior Survey. Forty-two percent of each race-gender group reported first intercourse before age 13, except for African American females at 63%. Seventy-five to 79% of all race-gender groups reported first sexual intercourse by age 18. Drinking alcohol before age 13 and carrying a weapon in the past 30 days were associated with first intercourse before age 13. Youth reporting first intercourse between ages 13 and 18 were about 12 times more likely to report suicide ideation than those youth who reported never having sexual intercourse. Youth with SED reporting first intercourse before age 13 appear to have an increased risk for unintended pregnancy and for contracting a sexually transmitted disease compared to youth with SED reporting first intercourse after age 13.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Patterns of adolescent involvement in problem behaviors: Relationship to self-efficacy,social competence,and life events

Using a sample of 556 adolescents from a suburban community, patterns of various adolescent problem behaviors (e.g., delinquent behavior, smoking, use of alcohol or drugs) and their links to self-efficacy, social competence, and life events were examined. Cluster analysis was conducted to identify four subgroups of adolescents who showed distinct patterns of problem behaviors. These clusters were compared on the measures of self-efficacy, social competence, and life events. Overall results suggest there are meaningful links between adolescents’ problem behavior patterns and self-efficacy, the amount and quality of participation in various after school activities, and life events. For example, a subgroup of adolescents who showed uniformly low prevalence of all problem behaviors reported more positive academic self-efficacy, more active participation in sports and nonsports activities, more positive life events, and fewer negative events than adolescents who were involved in multiple problem behaviors. Implications for prevention and future research on adolescent problem behaviors are discussed.     

GENERALIZATION OF THE EFFECTS OF TEACHER- AND SELF-ADMINISTERED TOKEN REINFORCERS TO NONTREATED STUDENTS

Ten, black, second-grade boys served in a series of single-subject studies. They were from poor families, did not do well in arithmetic, were deficient in sustained attention, and presented behavior problems at school. One boy was a therapeutic confederate. Of the remaining nine nontreated students, three observed the confederate reinforced by a teacher, three observed the confederate self-reinforce without having an opportunity to use “self-reinforcement” themselves, and three observed self-reinforcement while having an opportunity to use “self-reinforcement.” The target behavior was attending. Other measures of outcome were glancing, academic achievement, and accuracy of reinforcement. The basic experimental design consisted of an ABAB withdrawal applied to the confederate while the nontreated students remained on baseline. Generalization was expressed as a ratio (i.e., percent change in the generalization measure divided by percent change in the target behavior). Teacher-administered reinforcers to the confederate did not produce generalization of any kind. Both arrangements of self-administered reinforcers to the confederate produced across-subjects generalization and subject-response generalization. Additionally, the confederate manifested response generalization.     

Development of Adolescent Problem Behavior

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent–child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.     

Age trends in early behavioral predictors of serious antisocial behaviors

A risk group of disruptive boys (N=65) identified in kindergarten was assessed using the same procedures at ages 6–7, 8–9, and 10–11. Criteria used to define the predictors and criterion variable were the same at all assessment times. Severity was addressed by comparing different forms of behaviors, considering the extent of harmful consequences to others (aggressiveness was considered as most harmful, whereas inattention was considered as least harmful), manifestation in multiple settings, and extreme scores (manipulation of cutoff scores). Different assessment strategies (direct observations, ratings) and different informants (trained observers, mothers and teachers) were used. Aggressiveness as rated by mothers was highly stable from age 6 to age 11. Inattention as rated by teachers was stable only from age 6 to age 9, whereas no stability was found for observations of task inappropriate behaviors. Taskinappropriate behaviors observed in mother-child interactions and in multiple settings at age 6–7 were significant predictors of self-reported antisocial behaviors at age 12, but this prediction was not repeated at ages 8–9 and 10–11. Teacher ratings of inattention at ages 6–7 and 8–9 were also significant predictors of self-reported antisocial behaviors at age 12. The predictive power was much lower when mothers' ratings of aggressiveness were used. Findings from the present study support the hypothesis that some antisocial behavior precursors are age dependent, in that they are more characteristic of certain age groups than of others. Implications for the selection of assessment screening procedures are discussed.     

AN ANALYSIS OF AND INTERVENTION IN THE SEXUAL TRANSMISSION OF DISEASE

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing “occasion cards” for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.