Response to name in children with autism: Treatment,generalization, and maintenance

Deficits in response to name (RTN) are an early indicator of autism spectrum disorder (ASD), and RTN is a treatment goal in many early intervention curricula for children with ASD. However, little research has empirically evaluated methods for increasing RTN in children with ASD. We evaluated a series of conditions designed to increase RTN for 4 children with ASD using a multielement experimental design. The schedules of tangible reinforcement were thinned after mastery and generalization was tested across people and contexts. Tangible reinforcers were necessary to increase RTN for all 4 participants, and the schedule of reinforcement was successfully thinned with all participants after intervention. Generalization was also observed across people and experimental contexts.     

Examining generalization of motorist yielding at an adjacent crosswalk with variations of the gateway sign configuration

The gateway sign configuration has been effective at increasing motorist yielding and reducing speeds at crosswalks. A gateway configuration uses in-street signs at a crosswalk on each edge of the roadway and on each lane line. Although this intervention is effective at increasing motorist yielding at uncontrolled crosswalks, the limits of the intervention have yet to be tested. The present study examined if 1) the effects of the gateway intervention on one crosswalk would generalize to an untreated adjacent crosswalk, and 2) if the effects of an offset configuration of signs which partially treated each crosswalk could maximize the effects of that generalization. Experiment 1 showed that less yielding occurred at the untreated crosswalk than at the treated crosswalk, though yielding was higher than baseline. In Experiment 2, results showed that an offset gateway configuration could produce comparable levels of yielding at both crosswalks.     

A preliminary evaluation of treatment duration on the resurgence of destructive behavior

Quantitative models of resurgence (e.g., Behavioral Momentum Theory, Resurgence as Choice) suggest that resurgence is partly a function of the duration of extinction exposure, with longer histories of extinction producing less resurgence. This prediction is supported by some laboratory research and has been partially supported by clinical translations that did not isolate the effects of extinction exposure prior to testing for resurgence. The degree to which different histories of extinction impact the likelihood of treatment relapse in therapeutic applications of differential reinforcement is of great interest to the clinical community, including insurance carriers and other financial providers. In the present study, we isolated the effects of extinction history for severe destructive behavior across 6 participants referred for treatment services and examined resurgence of destructive behavior when alternative reinforcement terminated. Our within-subject evaluation showed no difference in the level of resurgence or persistence of destructive behavior following short and long exposures to differential reinforcement with extinction. We discuss our failure to replicate in relation to experimental-design considerations for investigating this and other relapse phenomena in future research with clinical populations.     

A Meta-Analysis of Program Characteristics for Youth with Disruptive Behavior Problems: The Moderating Role of Program Format and Youth Gender

There is high variability in efficacy for interventions for youth with disruptive behavior problems (DBP). Despite evidence of the unique correlates and critical consequences of girls’ DBP, there is a dearth of research examining treatment efficacy for girls. This meta-analysis of 167 unique effect sizes from 29 studies (28,483 youth, 50% female; median age: 14) suggests that existing treatments have a medium positive effect on DBP (g = .33). For both boys and girls, the most effective interventions included (a) multimodal or group format, (b) cognitive skills or family systems interventions, and (c) length-intensive programs for (d) younger children. Boys demonstrated significantly greater treatment gains from group format interventions compared to girls, which is particularly important given that the group program format was the most prevalent format for boys and girls, with 14 studies involving 10,433 youth encompassing this category. This is the first meta-analysis to examine the effect of program characteristics in a sample of programs selected to be specifically inclusive of girls. Given that girls are underrepresented in intervention research on DBP, findings are discussed in terms of gender-responsive considerations and elucidating how key aspects of program structure can support more effective intervention outcomes for youth.     

A comparison of teaching tacts with and without background stimuli on acquisition and generality

We evaluated whether teaching tacts of images with or without backgrounds would affect acquisition during teaching and generality across untaught targets with four children diagnosed with autism spectrum disorder. Including backgrounds could slow acquisition but bolster generality across other media containing backgrounds, whereas removing backgrounds may improve acquisition but result in poorer generality. Overall, acquisition rates were similar across conditions for three children, although one child displayed consistently slower acquisition during the background condition. We rarely observed generality to untaught targets when programming extinction, but embedding differential reinforcement or teaching additional images with backgrounds led to equally successful outcomes irrespective of initial teaching conditions. Teaching with or without backgrounds may result in marginal differences in acquisition of teaching and untaught targets, especially when arranging supplemental procedures during tests for generality. We discuss the importance of intrasubject replication, considerations when testing for generality, and implications for practice.     

Actions speak louder than words: Differences in memory flexibility between monolingual and bilingual 18‐month‐olds

Bilingual infants from 6‐ to 24‐months of age are more likely to generalize, flexibly reproducing actions on novel objects significantly more often than age‐matched monolingual infants are. In the current study, we examine whether the addition of novel verbal labels enhances memory generalization in a perceptually complex imitation task. We hypothesized that labels would provide an additional retrieval cue and aid memory generalization for bilingual infants. Specifically, we hypothesized that bilinguals might be more likely than monolinguals to map multiple perceptual features onto a novel label and therefore show enhanced generalization. Eighty‐seven 18‐month‐old monolingual and bilingual infants were randomly assigned to one of two experimental conditions or a baseline control condition. In the experimental conditions, either no label or a novel label was added during demonstration and again at the beginning of the test session. After a 24‐hr delay, infants were tested with the same stimulus set to test cued recall and with a perceptually different but functionally equivalent stimulus set to test memory generalization. Bilinguals performed significantly above baseline on both cued recall and memory generalization in both experimental conditions, whereas monolinguals performed significantly above baseline only on cued recall in both experimental conditions. These findings show a difference between monolinguals and bilinguals in memory generalization and suggest that generalization differences between groups may arise from visual perceptual processing rather than linguistic processing. A video abstract of this article can be viewed at https://youtu.be/yXB4pM3fF2k     

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.     

Treating a Chronically Depressed Adolescent Female Using the Cognitive Behavioral Analysis System of Psychotherapy: A Case Study

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administrations of the Minnesota Multiphasic Personality Inventory-Adolescent, weekly administrations of the Child Depression Inventory, and acquisition performance ratings on the SA task. The results showed that CBASP appeared to be an effective treatment. The double depressive disorder remitted, and the patient learned to identify behavioral consequences as well as target and attain her interpersonal goals. CBASP can be effective for adolescents, although modifications of the adult form of the therapy may be necessary.     

Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.