Parent-implemented behavioral skills training of social skills.

Impairment in social skills is a primary feature of Autism Spectrum Disorders (ASDs). Research indicates that social skills are intimately tied to social development and negative social consequences can persist if specific social behaviors are not acquired. The present study evaluated the effects of behavioral skills training (BST) on teaching four parents of children with ASDs to be social skills trainers. A nonconcurrent multiple baseline design across parent-child dyads was employed and direct observation was used to assess parent and child behaviors Results demonstrated substantial improvement in social skills teaching for all participants for trained and untrained skills. Ancillary measures of child performance indicated improvement in skills as well. High levels of correct teaching responses were maintained at a 1 month follow-up. This study extends current literature on BST while also providing a helpful, low-effort strategy to modify how parents can work with their children to improve their social skills.

The Munroe-Meyer Approach: Continuous Integration of Didactic Instruction, Research, and Clinical Practice.

Increased demand for applied behavior analysis (ABA) services has increased the need for additional masters-level practitioners and doctoral-level academicians and clinical directors. Based on these needs, the University of Nebraska Medical Center's (UNMC) Munroe-Meyer Institute has developed a PhD program. The academic structure at UNMC allowed us to create our PhD program in a relatively quick and efficient manner. Our PhD program has many unique features, including (a) close integration of didactic instruction with clinical and research training provided by leading experts in ABA in which students immediately apply concepts introduced in the classroom during coordinated clinical and research practica; (b) structured grant writing training in which students learn to write and submit an NIH-level grant;

Advancing Continence in Typically Developing Children: Adapting the Procedures of Foxx and Azrin for Primary Care.

OBJECTIVE: To (1) identify and summarize procedures of Foxx and Azrin's classic toilet training protocol that continue to be used in training typically developing children and (2) adapt recent findings with the original Foxx and Azrin procedures to inform practical suggestions for the rapid toilet training of typically developing children in the primary care setting. METHOD: Literature searches of PsychINFO and MEDLINE databases used the search terms "(toilet* OR potty* AND train*)." Selection criteria were only peer-reviewed experimental articles that evaluated intensive toilet training with typically developing children. Exclusion criteria were (1) nonpeer reviewed research, (2) studies addressing encopresis and/or enuresis, (3) studies excluding typically developing children, and (4) studies evaluating toilet training during infancy. RESULTS: In addition to the study of Foxx and Azrin, only 4 publications met the above criteria. Toilet training procedures from each article were reviewed to determine which toilet training methods were similar to components described by Foxx and Azrin. Common training elements include increasing the frequency of learning opportunities through fluid loading and having differential consequences for being dry versus being wet and for voiding in the toilet versus elsewhere. CONCLUSION: There is little research on intensive toilet training of typically developing children. Practice sits and positive reinforcement for voids in the toilet are commonplace, consistent with the Foxx and Azrin protocol, whereas positive practice as a corrective procedure for wetting accidents often is omitted. Fluid loading and differential consequences for being dry versus being wet and for voiding in the toilet also are suggested procedures, consistent with the Foxx and Azrin protocol.

A Methodological Discussion of Caffeine Research and Animal Avoidance Behavior.

Introduction: We present a review of the methodological aspects of caffeine research within animal tests of escape and avoidance behavior in the presence of aversive stimuli. Method: We highlight species, methods of caffeine administration, dosage, dependent measures, and research designs commonly used in this research. Results: Typical subjects were rodents and zebrafish, with species-specific vehicles of caffeine administration and dependent measures. Behavioral tests for escape and avoidance as a function of caffeine consumption were conceptually similar across species, although the arrangement of measures was necessarily adapted to the physiological contingencies of the different species. Discussion and Conclusions: Caffeine administration preceding the presentation of aversive stimuli generally, but not exclusively, enhanced the effect of escape and avoidance of aversive stimuli. The many commonalities in methods and results across species suggest similar methods may be relevant to human subjects as well.

Psychological and psychiatric issues in urinary and fecal incontinence.

PURPOSE: We provide an overview of the psychological and psychiatric aspects of nocturnal enuresis, urinary and fecal incontinence. Clinical behavioral disorders and subclinical psychological symptoms are reviewed. Aspects of screening, assessment, counseling and in severe cases treatment are outlined, and recommendations are formulated. MATERIALS AND METHODS: Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding, and were circulated among International Children's Continence Society members and external experts. RESULTS: In addition to subclinical effects on self-esteem, quality of life and distress, the rate of comorbid clinical behavioral disorders is increased. In fact, 20% to 30% of children with nocturnal enuresis, 20% to 40% with daytime urinary incontinence and 30% to 50% with fecal incontinence fulfill the criteria for ICD-10 or Diagnostic and Statistical Manual of Mental Disorders IV psychiatric disorders. These concomitant disturbances require assessment and counseling, and in severe cases treatment. They have a negative effect on compliance and outcome if not addressed and left untreated. CONCLUSIONS: Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with enuresis and/or daytime urinary and/or fecal incontinence. Standardized, validated questionnaires are recommended. In addition to clinical observation and history, a short screening questionnaire can be used as a first step. If problem behaviors are present a longer broadband questionnaire is recommended. If problem items in the clinical range are noted, a full child psychiatric or psychological assessment is recommended.

Caffeine consumption in young children.

Two hundred twenty-eight surveyed parents reported that their 5 to 7 year old children drank approximately 52 mg of caffeine daily and their 8 to 12 year old children drank 109 mg daily. Caffeine consumption and hours slept were significantly negatively correlated, but caffeine consumption and enuresis were not significantly correlated. Spanish-speaking parents reported fewer bedwetting events than their English-speaking peers.

Toilet training in primary care: current practice and recommendations from behavioral pediatrics.

This article is the first to evaluate pediatricians' (1). current practices regarding recommendations for toilet training typically developing first-time learners and (2). opinions on an intensive procedure for rapid toilet training. Results of surveys obtained from 103 pediatricians indicate that physicians' recommendations lean toward a gradual, passive approach to toilet training with 72% endorsing "child interest" in the toilet as one of the top criteria children must exhibit before beginning training. Respondents had a somewhat unfavorable view of intensive toilet training for first-time learners with 29% endorsing the use of such a procedure, although in most cases without all of the components. It is recommended that some components of the intensive procedure could easily "fit" with physicians' current practices to increase toilet-training effectiveness within a shorter training interval. These recommendations, including compliance training as a part of teaching, increased fluid intake to promote toileting trials, and multiple training sits, are described.

Coping with Prader-Willi syndrome.

Weight- and behavior-control issues are major concerns for parents of a child with Prader-Willi syndrome. However, limited information is available on how families implement the necessary dietary restrictions and the effects of the strategies. This study identified the advice a group of families received regarding weight management, the nutrition concerns they faced and how they coped with these concerns, and the effectiveness of their coping strategies. A 2-step survey methodology was used. Survey 1 identified the strategies parents used to cope with the feeding issues typically presented by children with Prader-Willi syndrome. Survey 2 evaluated the frequency with which these coping strategies were used and their effectiveness. Respondents also provided information on why strategies were not effective. Surveys were mailed to 496 parents/guardians of children (aged 25 years or younger) with Prader-Willi syndrome. A total of 293 (64%) responded. Advice given to families centered on general weight management and dietary guidance. Difficulties centered around coping with food-related behaviors. Coping strategies varied; what worked for 1 family did not necessarly work for another. Participants indicated a desire to share experiences and a need for specific strategies to cope with feeding-behavior difficulties. A few basic behavior-management strategies, including successful use of incentives, responding to misbehavior, rewarding compliance with an exercise program, and modifying the behavior management when indicated, are briefly reviewed.