ABSTRACT
Typically behaviour management plans attempt to change behaviour by manipulating the environmental consequences of selected behaviour. However, identifying the antecedent events that precede behaviour has also been demonstrated to be an important component of effective behaviour change programmes. The present case presentation attempts to demonstrate how antecedent procedures could be used to effectively manage behaviour problems in individuals with brain injury. Visual inspection of changes in the frequency of physical aggression and self-injurious behaviour of a child with brain injury provides preliminary data supporting the use of an intervention package of antecedent and consequence-based procedures. Clinical implications, limitations and possibilities for future research of antecedent control procedures are discussed.
Subject(s)
Behavior Therapy/methods , Brain Injuries/complications , Child Behavior Disorders/therapy , Aggression/psychology , Brain Injuries/psychology , Brain Injuries/rehabilitation , Child , Child Behavior Disorders/etiology , Child Behavior Disorders/psychology , Humans , Joints/physiopathology , Male , Physical Therapy Modalities , Proprioception/physiology , Self-Injurious Behavior/etiology , Self-Injurious Behavior/psychology , Self-Injurious Behavior/therapy , Social Environment , Treatment OutcomeABSTRACT
The sleep-awakening disruption of an adolescent with developmental disabilities was treated using an antecedent control intervention that identified his consistent time of wake-up, provided the presence of a preferred staff in his bedroom, and prompted social interaction from staff before challenging behaviors occurred. Positive findings were documented using a combined reversal and multiple baseline across settings design, with results maintained through a 9-month follow-up. A partial component analysis of the intervention plan suggested that the presence of preferred staff was the influential antecedent variable.
Subject(s)
Intellectual Disability/psychology , Sleep-Wake Transition Disorders/psychology , Sleep-Wake Transition Disorders/therapy , Adolescent , Behavior Therapy , Humans , Male , Reinforcement, PsychologyABSTRACT
Recent advances in pharmacological treatment of severe behavior disorders in persons with developmental disabilities suggest the use of antidepressant medication for therapeutic management. This research evaluated two antidepressant medications for treatment-resistant aggression and self-injury exhibited by two persons with developmental disabilities. Behavioral assessment data documented that sertraline (a serotonin selective reuptake inhibitor) was effective in reducing self-injurious behaviors in a 20-year-old man with severe mental retardation and clomipramine (a tricyclic antidepressant) was associated with the elimination of aggressive behavior in a 14-year-old boy with autism. Clinical effects from the medications were measured in relation to and shown to be a function of dosage level. Extended follow-up assessments revealed maintenance of treatment gains with continued medication administration.
Subject(s)
Aggression/drug effects , Antidepressive Agents/administration & dosage , Behavior Therapy , Intellectual Disability/drug therapy , Residential Treatment , Self-Injurious Behavior/drug therapy , Adolescent , Adult , Aggression/psychology , Antidepressive Agents/adverse effects , Clomipramine/administration & dosage , Clomipramine/adverse effects , Combined Modality Therapy , Humans , Intellectual Disability/psychology , Long-Term Care , Male , Self-Injurious Behavior/psychology , Sertraline/administration & dosage , Sertraline/adverse effects , Treatment OutcomeABSTRACT
The long-term maintenance of behavioral treatment effects is an important measure of clinical significance but is not reported with regularity in the published literature. The present report concerned therapeutic maintenance by evaluating five adults with developmental disabilities who had been exposed to multiple, restrictive procedures (food deprivation, mechanical restraint, electric shock) in a prior residential treatment facility and were transitioned to a new habilitation setting where these procedures were terminated in favor of alternative methods of behavior support. As revealed through a 24-month follow-up period, all of the participants were able to maintain clinically acceptable levels of challenging behaviors following the removal of the restrictive treatment procedures. Quality of life measures also revealed that the participants experienced greater independence, reduced supervision, and increased diversity in their living and work environments. These findings add to the limited studies on extended maintenance outcomes from behavioral intervention for serious clinical disorders in adults with developmental disabilities by demonstrating that positive adjustment can be sustained in the long-term without the continuation of restrictive treatment procedures.
Subject(s)
Behavior Therapy , Deinstitutionalization , Intellectual Disability/rehabilitation , Social Adjustment , Social Support , Activities of Daily Living/psychology , Adult , Day Care, Medical , Follow-Up Studies , Humans , Intellectual Disability/psychology , Male , Quality of Life , Rehabilitation, Vocational , Reinforcement, PsychologyABSTRACT
A 3-year-old child with multiple medical disorders and chronic food refusal was treated successfully using a program that incorporated antecedent control procedures combined with positive reinforcement. The antecedent manipulations included visual cueing of a criterion number of self-feeding responses that were required during meals to receive reinforcement and a gradual increase in the imposed criterion (demand fading) that was based on improved frequency of oral consumption. As evaluated in a changing criterion design, the child learned to feed himself as an outcome of treatment. One year following intervention, he was consuming a variety of foods and had gained weight. Advantages of antecedent control methods for the treatment of chronic food refusal are discussed.
Subject(s)
Behavior Therapy/methods , Feeding Behavior/psychology , Feeding and Eating Disorders/therapy , Child, Preschool , Chronic Disease , Cues , Extinction, Psychological , Feeding and Eating Disorders/psychology , Humans , Male , Parent-Child Relations , Reinforcement, Psychology , Treatment OutcomeABSTRACT
Many persons who have developmental disabilities and challenging behaviors are treated with multiple medications combined with nonpharmacological approaches. However, the comparative effects from pharmacotherapy frequently are not assessed empirically, do not include corollary behavioral measures, and are not evaluated in the long term. The present single-case study incorporated behavioral assessment methodology in an "open label" evaluation of anticonvulsant (clonazepam), beta-blocking (propanolol), and antidepressant (sertraline and clomipramine) medications on severe aggression in a child with autism. Clinically significant reductions in aggressive behavior were attained with the administration of clomipramine and the reductive effects from the medication persisted for 1.7 years. In addition, clomipramine was associated with the elimination of crisis intervention procedures that had been required to manage the child's aggression. These findings add to the clinical literature describing effective treatment of serious behavior disorders in persons with developmental disabilities using antidepressant medication.
Subject(s)
Aggression/drug effects , Autistic Disorder/drug therapy , Clomipramine/administration & dosage , Clonazepam/administration & dosage , Propranolol/administration & dosage , Sertraline/administration & dosage , Autistic Disorder/diagnosis , Autistic Disorder/parasitology , Child , Clomipramine/adverse effects , Clonazepam/adverse effects , Crisis Intervention , Dose-Response Relationship, Drug , Drug Administration Schedule , Follow-Up Studies , Humans , Male , Propranolol/adverse effects , Sertraline/adverse effects , Treatment OutcomeABSTRACT
Research has demonstrated that providing extra and sometimes unlimited food quantities following meals can be effective in reducing or eliminating ruminative vomiting in persons with developmental disabilities. In this study, providing access to white bread was evaluated as an alternative method of satiation-based treatment of rumination displayed by an 18-year old male with mental retardation. White bread was made available during 1-h periods following daily meals and this intervention produced a reduction in ruminating to near zero levels throughout the young man's waking hours. Long-term follow-up assessment revealed maintenance of low-frequency responding. Issues related to satiation treatment programs for ruminative vomiting are discussed.
Subject(s)
Bread , Feeding Behavior/psychology , Feeding and Eating Disorders of Childhood/diagnosis , Feeding and Eating Disorders of Childhood/prevention & control , Vomiting/prevention & control , Vomiting/psychology , Adolescent , Animals , Chronic Disease , Humans , MaleABSTRACT
We report the successful treatment of persistent self-injurious behavior (SIB) in a 9-year-old girl with pervasive developmental disorder. The girl had inflicted severe tissue damage to her face, neck, and inner thighs due to pinching, scratching, and rubbing of her skin. Using a rating scale to quantify surface tissue damage produced by SIB, the number of bodily injuries, the intensity of skin trauma, and the projected risk of further physical harm decreased dramatically following the administration of clonidine that was titrated to a maximum dose of 0.4 mg daily. The girl's SIB showed marked improvement over a 24-month period of observation. Issues related to pharmacotherapy of SIB using alpha adrenergic agonists are discussed.
Subject(s)
Adrenergic alpha-Agonists/therapeutic use , Clonidine/therapeutic use , Developmental Disabilities/drug therapy , Self-Injurious Behavior/drug therapy , Child , Clonidine/adverse effects , Female , HumansABSTRACT
Although a common problem encountered by mental health specialists, there are few published descriptions of behavior therapy intervention for childhood stealing. The present case study addresses the behavioral treatment of stealing exhibited by a child in a pubic school setting. A functional assessment suggested that the behavior was maintained by the social attention it elicited from school personnel and parents. Using an hypothesis-driven model of treatment formulation, intervention consisted of eliminating multiple sources of attention in an extinction paradigm. Intervention was associated with a systematic reduction in stealing and results were maintained through a 12-month follow-up. Issues related to functionally determined treatment of behavior disorders are discussed.
Subject(s)
Behavior Therapy/methods , Child Behavior Disorders/therapy , Social Control, Informal , Theft/psychology , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Child , Child Abuse/psychology , Child Behavior Disorders/psychology , Education, Special , Female , Follow-Up Studies , Humans , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy , Social Environment , Token EconomyABSTRACT
An 8-year old boy with Pervasive Developmental Disorder (PDD) was taught toileting skills within a public elementary school. During baseline, he never urinated successfully in the toilet and wore a disposable diaper throughout the day. The training program included scheduling a toileting opportunity at a time that increased the likelihood of urination and providing positive reinforcement when voiding in the toilet occurred. Toileting skills were established rapidly and were maintained when another bathroom visit was added to the toileting schedule, primary reinforcement was eliminated, and the boy no longer wore a disposable diaper. Issues related to behavioral support programming within inclusive educational settings are discussed.
Subject(s)
Behavior Therapy/methods , Developmental Disabilities/rehabilitation , Toilet Training , Child , Humans , Longitudinal Studies , Male , School Health Services , Teaching/methodsSubject(s)
Human Coprophagia/psychology , Obsessive-Compulsive Disorder/psychology , Pica/psychology , Adolescent , Adult , Behavior Therapy , Female , Human Coprophagia/diagnosis , Human Coprophagia/therapy , Humans , Male , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapy , Pica/diagnosis , Pica/therapy , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
A treatment package that included two setting condition manipulations and visual occlusion was implemented to gain control over the high-intensity screaming and whining of a 16-year-old female with developmental disabilities. The study included an analysis of the individual and combined components of the treatment package and a stimulus control analysis of three salient features of the visual occlusion apparatus (i.e., opaque screen, secured helmet, and cranial pressure). Results showed that the treatment package occasioned a deceleration in the two targeted vocal behaviors and a reduction in the amount of time the participant was required to wear the occlusion apparatus. An analysis of the apparatus suggested that the critical element needed to control inappropriate vocalizations appeared to be cranial pressure, which was naturally produced by the helmet. Consequently, the helmet was eliminated and cranial pressure was produced by a woman's headband. Follow-up data, collected 1, 2, and 3 months after termination of systematic intervention, revealed near-zero levels of screaming and whining behaviors. A 9-month follow-up investigation involving the removal and subsequent reinstatement of the headband procedure supported the use of the headband for the maintenance of behavioral gains.
Subject(s)
Behavior Therapy/methods , Disabled Persons/psychology , Intellectual Disability/therapy , Adolescent , Combined Modality Therapy , Crying , Female , Follow-Up Studies , Humans , Intellectual Disability/psychology , Language Development Disorders/psychology , Language Development Disorders/therapy , Reinforcement Schedule , Social BehaviorABSTRACT
This case study describes the functional assessment and treatment of aggressive and destructive behaviors in a 14-year-old male child with a history of physical abuse. Evaluation was performed in a classroom within a residential school setting. Functional assessment in forms of indirect and descriptive methods was used to generate hypotheses regarding sources of behavioral control. A treatment plan that combined multi-level differential reinforcement of other behavior (DRO) and positive reinforcement for task completion was implemented based on the outcome of functional assessment. Treatment was associated with a gradual and steady reduction in challenging behaviors with near-zero rates achieved at follow-up. This case provides an example of clinical intervention for behavior disorders commonly observed in children who have been abused physically and a hypothesis-driven model of treatment formulation.
Subject(s)
Aggression/psychology , Behavior Therapy/methods , Child Abuse/therapy , Child Behavior Disorders/therapy , Adolescent , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit Disorder with Hyperactivity/therapy , Child , Child Abuse/psychology , Child Behavior Disorders/psychology , Defense Mechanisms , Education, Special , Humans , Male , Personality Development , Residential Treatment , Token EconomyABSTRACT
A multiple baseline design across instructional sessions was used to evaluate the therapeutic effects of noncontingent sensory reinforcement on stereotypic behaviors (grabbing and mouthing objects) displayed by an 8-year-old child with posttraumatic neurological impairment. The programmed sensory reinforcement was oral stimulation made accessible to the child by allowing her to chew on a designated and acceptable stimulus. Treatment was associated with a decrease in both object-grabbing and object-mouthing behaviors to near-zero levels. At a 6-month follow-up, the behaviors were absent without the use of sensory reinforcement. Issues of treatment formulation and implementation are discussed.
Subject(s)
Behavior Therapy/methods , Brain Damage, Chronic/rehabilitation , Intellectual Disability/rehabilitation , Reinforcement, Psychology , Stereotyped Behavior , Brain Damage, Chronic/psychology , Child , Education of Intellectually Disabled , Female , Follow-Up Studies , Humans , Hypoxia, Brain/complications , Hypoxia, Brain/psychology , Intellectual Disability/psychology , Mastication , Token Economy , Treatment OutcomeABSTRACT
Treated persistent ruminative vomiting of a 15-year-old boy with autism using a multicomponent behavioral medicine program within a residential facility. Preceding intervention the boy had lost 15 pounds associated with high-rate ruminating. The treatment program included a combination of dietary, nutritional, and behavioral procedures that emphasized food restrictions, satiation, and setting condition manipulations. Ruminative vomiting was reduced to near-zero levels and weight gain was achieved following treatment implementation. These therapeutic gains were sustained during a maintenance programming phase and at 1- through 4-month follow-up assessments. Issues related to functional assessment and treatment formulation in behavioral medicine intervention for ruminative vomiting are discussed.
Subject(s)
Autistic Disorder/therapy , Behavior Therapy/methods , Stereotyped Behavior , Vomiting/therapy , Weight Loss , Adolescent , Autistic Disorder/psychology , Combined Modality Therapy , Feeding Behavior/psychology , Humans , Lead Poisoning/psychology , Lead Poisoning/therapy , Male , Patient Care Team , Residential Treatment , Vomiting/psychologyABSTRACT
Mechanical restraint devices are sometimes used to prevent challenging behavior displayed by persons with disabilities. However, regulatory guidelines seek to prohibit or restrict the use of restraint in many residential programs. This research evaluated the implementation of restraint-elimination interventions with two students in a pediatric nursing care setting. Assessment and treatment procedures were developed and coordinated through a multidisciplinary, consultative team approach. Mechanical restraints were eliminated successfully with both students following application of individually designed treatment plans. Issues related to restraint-elimination programming and behavioral intervention within pediatric nursing care facilities are discussed.
Subject(s)
Nursing Care , Pediatrics , Restraint, Physical , Adult , Behavior Therapy , Child , Female , Humans , Mental Disorders/therapy , Orthotic Devices , Reinforcement, PsychologyABSTRACT
This research concerned the treatment of chronic food refusal in 2 children with multiple developmental disabilities. Therapeutic intervention consisted of a multicomponent treatment package that included the (a) elimination of feeding "demands" that provoked child agitation, (b) incorporation of sensory stimulation as contingent reinforcement, and (c) gradual introduction of the requirements for oral consumption. Each child received treatment during individualized training sessions and, subsequently, under naturalistic mealtime conditions. Consistent oral consumption was achieved rapidly by both children. Results were maintained at follow-up assessments ranging from 4 to 12 months.
Subject(s)
Behavior Therapy , Disabled Persons/psychology , Enteral Nutrition , Failure to Thrive/therapy , Feeding and Eating Disorders/therapy , Association Learning , Child , Failure to Thrive/psychology , Feeding and Eating Disorders/psychology , Female , Food Preferences/psychology , Humans , Male , Reinforcement ScheduleABSTRACT
There are very few studies that describe programs to train self-feeding skills in young children who are deaf and blind. This research reports two single-case studies on the acquisition of self-feeding in children with developmental disabilities and combined visual and auditory impairments. Study 1 included the use of prompting, prompt-fading, and contingent sensory reinforcement procedures to train independent self-feeding in a 7-year-old girl. Study 2 incorporated social reinforcement and response interruption to refine the self-feeding skills of a 6-year-old boy. Both studies were conducted by direct-care providers within an educational setting and reported maintenance of skill acquisition at 4 and 8 months posttraining.
Subject(s)
Activities of Daily Living/psychology , Behavior Therapy , Blindness/rehabilitation , Deafness/rehabilitation , Feeding Behavior , Blindness/psychology , Child , Deafness/psychology , Education, Special , Female , Humans , MaleABSTRACT
This case study evaluated a multicomponent behavioral medicine treatment package for chronic ruminating and vomiting in a 13-year-old child with multiple disabilities. Treatment incorporated dietary and medication manipulations combined with behavioral intervention. The treatment package was designed and evaluated via a consultative model in a residential-care setting. The child's ruminative vomiting decreased steadily with implementation of treatment and reduced rates were maintained 2 years later. This case illustrates collaboration between physicians and psychologists in developing comprehensive behavioral medicine interventions for health-threatening clinical disorders.
Subject(s)
Deglutition Disorders/physiopathology , Stomach, Ruminant/physiopathology , Vomiting/physiopathology , Adolescent , Animals , Behavior Therapy , Brain/physiopathology , Brain Diseases/complications , Brain Diseases/congenital , Deglutition Disorders/complications , Deglutition Disorders/therapy , Diet Therapy , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/physiopathology , Humans , Intellectual Disability/complications , Intellectual Disability/physiopathology , Male , Vomiting/complications , Vomiting/therapyABSTRACT
The severe and high-rate self-injurious (face slapping) behavior of a woman who was deaf and legally blind was reduced to near-zero levels following implementation of a multicomponent treatment program in combination with psychotropic medication. Behavioral treatment incorporated the noncontingent wearing of a protective helmet, rearrangement of social contingencies, and gradual fading of the helmet in a transfer of stimulus control paradigm. The client was prescribed lithium shortly after the introduction of the behavioral program and the dosage was increased over the course of treatment. A six-month follow-up revealed a near-absence of self-injury. Several explanations for the therapeutic control from the behavioral-pharmacological intervention are presented.
