What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Functional analyses and treatment of precursor behavior

Functional analysis has been demonstrated to be an effective method to identify environmental variables that maintain problem behavior. However, there are cases when conducting functional analyses of severe problem behavior may be contraindicated. The current study applied functional analysis procedures to a class of behavior that preceded severe problem behavior (precursor behavior) and evaluated treatments based on the outcomes of the functional analyses of precursor behavior. Responding for all participants was differentiated during the functional analyses, and individualized treatments eliminated precursor behavior. These results suggest that functional analysis of precursor behavior may offer an alternative, indirect method to assess the operant function of severe problem behavior.     

EVALUATION OF A MULTICOMPONENT INTERVENTION FOR DIURNAL BRUXISM IN A YOUNG CHILD WITH AUTISM

Bruxism, forceful grinding of one's teeth together, can produce destructive outcomes such as wear on the teeth and damaged gums and bone structures. The current study implemented a multicomponent intervention that consisted of vocal and physical cues to decrease rates of bruxism. A partial component analysis suggested that the vocal cue was only effective at decreasing levels of bruxism when paired with a simultaneous physical cue.     

Parental assessment and treatment of food selectivity in natural settings

This study evaluated the effects of a parent-conducted functional analysis and treatment consisting of differential reinforcement of an alternative behavior, escape extinction, and demand fading on food selectivity in a young child with autism. Increases in food acceptance at home and in a restaurant were obtained.     

Reinforcer identification and evaluation of choice within an educational setting

Current research on preference methodology and the effects of choice with children who are typically developing is limited. This study evaluated two preference methodologies for identifying reinforcers across two choice options within the classroom. These methods include a teacher-generated list of reinforcers, a student-generated list of reinforcers, student choice from both lists, and teacher choice from both lists. Four elementary aged-children with no diagnosed learning or developmental disabilities participated. Both preference methods were effective in identifying reinforcers for all participants. Moreover, both choice options resulted in increases in responding. Results are discussed with respect to reinforcement and the effects of “choice.”     

Teaching a perspective‐taking component skill to children with autism in the natural environment

We evaluated procedures for teaching three children diagnosed with autism spectrum disorder the perspective‐taking component skill of tacting what others are sensing across all five senses: see, taste, feel, hear, and smell. Using a multiple baseline across participants design, we evaluated a training package consisting of multiple exemplar training, reinforcement, and error correction. The treatment package was implemented in the natural environment and was effective for teaching participants to tact what others sensed. Generalization across untrained stimuli and people was observed from baseline to posttraining for all participants. We discuss how this component skill may be related to teaching further skills related to perspective taking such as tacting what others know, predicting future behavior based upon one's beliefs, and creating false beliefs in others for the purpose of adaptive deceptive behaviors such as keeping secrets, surprises, and bluffing during games.     

Teaching children with autism to seek help when lost in public

Children with autism may not develop safety skills (e.g., help-seeking behaviors) without explicit teaching. One potentially hazardous situation is when a child with autism becomes separated from caregivers in a retail establishment or other public setting. The purpose of this study was to evaluate a treatment package (rules, role playing, and praise) delivered in the natural environment for teaching 3 boys with autism to seek assistance from store employees when they became lost. Treatment was effective, and help-seeking behaviors generalized to untrained stores for all participants.