Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Effects of a Contingency for Quiz Accuracy on Exam Scores.

Completing frequent quizzes can improve exam scores; however, there is a lack of research on variables that influence quiz accuracy and whether there is an effect on exam scores. This study evaluated the effects of a contingency for quiz accuracy on quiz accuracy and exam performance. Eighty-one students enrolled in an introductory Learning course participated. For each class meeting and its related readings, the instructor assigned an online quiz due just before each class. During the no-contingency condition, the instructor assigned quizzes, but quiz accuracy did not result in points toward the final grade. During the accuracy-contingency condition, students earned points based on quiz accuracy. In a reversal design, the accuracy-contingency increased quiz accuracy and exam scores relative to no-contingency. Although many students benefited from the contingency, low-performing students were least likely to show a meaningful improvement in exam scores.

Correction to: Effects of a Contingency for Quiz Accuracy on Exam Scores.

[This corrects the article DOI: 10.1007/s40617-018-0226-z.].

The Use of Behavioral Skills Training to Teach Graph Analysis to Community Based Teachers.

In this study, the experimenter trained three teachers to implement data decision rules to detect when instructional changes should be made during the visual analysis of discrete-trial percentage graphs. The experimenter used a concurrent, multiple-baseline design across participants. The experimenter trained the teachers to follow decision-making rules using instruction, modeling, rehearsal, and feedback. Following intervention, participants increased the percentage of correct data-based decisions and decreased the percentage of errors.

The effects of pairing non-preferred staff with preferred stimuli on increasing the reinforcing value of non-preferred staff attention.

This two-part study conducted preference assessments for staff members in three adults with intellectual disabilities and then paired attention from non-preferred staff with preferred stimuli. All three participants reliably identified preferred and non-preferred staff in both verbal and pictorial preference assessments, they emitted a higher rate responses during progressive ratio schedules for attention from preferred than from non-preferred staff and emitted more approach responses to preferred than non-preferred staff. When attention from non-preferred staff was paired with preferred stimuli, break points and the rate of approaches to non-preferred staff systematically increased as a function of stimulus pairings. The paper discusses the implications of preparing staff to work with people with intellectual disabilities.

The effects of in-service training alone and in-service training with feedback on data collection accuracy for direct-care staff working with individuals with intellectual disabilities.

Three residential staff aged 22-38 years participated in this study which measured the accuracy of their data collection, following instruction, in-service, and in-service plus feedback. The experimenter trained them to collect data on targeted maladaptive behavior of one consumer at one time of the day. Following the in-service and the in-service plus feedback trainings, the experimenters assessed whether data collection accuracy increased for that consumer at that time and whether these improved data collection skills generalized to the other consumers and different times. The experimenter used a multiple-baseline-across-participants design to demonstrate experimental control. All three staff improved their data-collection-accuracy from instruction to in-service, and then from in-service to in-service plus feedback. Additionally, improved data collection generalized to two different consumers and two separate time periods. Future research should extend these findings of this study to measuring the effects of more accurate data collection on other functional dependent variables such as accuracy of staff implementation of behavior plans, frequency of maladaptive behavior and amount of prescribed psychotropic medications.

Evaluation of the observer effect on compliance training in adolescents with autism.

Three mothers conducted behavioral observations of video clips of a mother conducting compliance training to varying degrees of accuracy. Subsequently, two mothers correctly conducted compliance training and their children emitted compliant behavior. Upon addition of feedback, the third mother correctly implemented compliance training and her child also emitted complaint behavior. Conducting behavioral observations may be a viable and efficient option for training parents to conduct compliance training and, if ineffective, can be supplemented by feedback.

The effects of behavioral skills training on instructor and learner behavior across responses and skill sets.

Behavioral skills training (BST) is effective to train staff to provide intervention to people with developmental disabilities. The purpose of this study was to assess whether: (a) prior studies demonstrating the effectiveness of BST could be systematically replicated while teaching multiple teaching instructors to implement discrete trial teaching, incidental teaching and activity schedules; (b) instructional skills that staff acquired during training on one response generalized to a variety of instructional programs, (c) positive changes in staff performance produced positive behavior change in learners; and (d) positive changes in learner behavior generalized to novel programs. BST resulted in positive behavior change across staff, learners, instructional programs, and various teaching skills. Further, staff generalized teaching skills to novel responses and learners displayed increases in correct responding for all three instructional procedures. Social validity data indicated they these staff training procedures were highly acceptable and effective. Thus, BST is an effective and acceptable staff training procedure.

Increasing responding to others' joint attention directives using circumscribed interests.

Children with autism show significant deficits in joint attention (JA), which occurs when 2 people engage in verbalizations, gestures, or eye contact with each other and a common object. Children with autism also exhibit intense interests in specific topics (i.e., circumscribed interests; CI). This study investigated the effectiveness of teaching responding to JA directives (RJA) to 3 children with autism while engaged in CI activities. RJA increased during intervention and generalized from CI to preferred activities.

Using behavioural skills training to treat aggression in adults with mild intellectual disability in a forensic setting.

BACKGROUND: Previous studies of anger management in people with intellectual disability failed to control for the effects of the number of provocative stimuli presented and lacked direct measures of behaviour and treatment integrity data. METHODS: This experiment systematically assessed and presented discriminative stimuli for aggressive behaviour, taught alternative behaviour in response to discriminative stimuli for aggressive behaviour and used behavioural skills training with three adults with mild intellectual disability. RESULTS: Following behavioural skills training, the adult's percentage of aggressive responses declined and replacement responses increased in response to provocative stimuli. Treatment gains generalized to novel antecedent events, novel staff and novel settings and were socially valid. After intervention, community trips increased for all three participants. CONCLUSIONS: Behavioural skills training to teach alternate behaviour to aggression with carefully planned procedures to promote generalization caused a socially valid increase in alternate behaviour and a socially valid decrease in aggression.

Therapist characteristics predict discrete trial teaching procedural fidelity.

Early intensive behavioral intervention is generally effective for children with autism spectrum disorder but is associated with variability in treatment outcome and quality of treatment delivery may contribute to this. This study examined the relationship between therapist personality, attitude toward individuals with a disability, and perceived relationship between therapist and child on procedural fidelity. Discrete Trial Teaching (DTT) was provided at a preschool for children with intellectual disabilities. Seventy DTT sessions between 22 therapists and 35 children were videotaped and analyzed. Data on therapist's attitude toward individuals with a disability, therapist's personality traits, and perceived relationship between therapist and child were also collected. Procedural fidelity was high and significantly related to therapist's attitude toward individuals with a disability, therapist's openness to experience, and perceived relationship between therapist and child. Therapists with high procedural fidelity tended to have a more positive attitude toward individuals with disabilities on the cognitive dimension, a more negative attitude toward individuals with disabilities on the affect dimension, lower levels of openness to experience, and perceived the relationship between themselves and the child as less positive.

Treatment of psychopathology in people with intellectual and other disabilities.

OBJECTIVE: To review the psychosocial, pharmacological, and other treatments of psychopathology in people with intellectual disabilities (IDs), autism, and other developmental disabilities (DDs). METHOD: Systematic reviews and meta-analyses of psychosocial, pharmacological, and other treatments for people with DDs are reviewed. RESULTS: There is strong evidence for applied behaviour analysis (ABA) and other behavioural treatments of some forms of psychopathology. There is little good evidence to support the effectiveness of cognitive-behavioural therapy, cognitive therapy, sensory interventions, and other forms of psychosocial interventions. Recently, more randomized controlled trials (RCTs) of psychopharmacology have been published, especially with people with autism spectrum disorders. Most RCTs were for externalizing behaviour problems, rather than for psychopathology. These RCTs offer only preliminary support for the effectiveness of pharmacotherapy. No evidence was found for the effectiveness of other biological treatments. CONCLUSIONS: Current research supports the use of ABA and other behavioural interventions for some forms of psychopathology. Evidence for the effectiveness of other interventions is limited or absent.

Effects of behavioral skills training on parental treatment of children's food selectivity.

We used behavioral skills training to teach parents of 3 children with autism spectrum disorder and food selectivity to conduct a home-based treatment package that consisted of taste exposure, escape extinction, and fading. Parent performance following training improved during both taste sessions and probe meals and was reflected in increases in children's acceptance of bites and decreases in their disruptive behavior. Parents also reported that increases in diet variety were maintained at follow-up.

Generalization procedures in training interventionists for individuals with developmental disabilities.

The literature pertaining to training staff, parents, and peers to implement interventions for individuals with developmental disabilities was reviewed for training procedures that incorporated strategies to promote generalization. The search engines for the Journal of Applied Behavior Analysis and Pubmed© were used to find relevant studies. Studies met the inclusion criteria if they sufficiently operationalized their training procedure, took data on individual trainees' performance, and used a single-subject experimental design. The training procedures were coded for generalization procedures as per Stokes and Baer. Of the 54 studies, 46 considered used procedures to promote generalization. The most prevalent generalization procedures were use of common stimuli, followed by using sufficient exemplars and mediated generalization. Studies demonstrated empirical support for these procedures producing generalized use of newly acquired direct-care skills. The remaining generalization procedures cited in Stokes and Baer were absent or far less prevalent. Future research should explore the use of these procedures and their effectiveness as a technology to bring about generalized responding of interventionists' skills.

Effects of general-case training, instructions, rehearsal, and feedback on the reduction of sight-reading errors by competent musicians.

We used general-case training, instructions, rehearsal, and feedback to teach 3 advanced flute students to improve their sight-reading skills. Training resulted in systematic decreases in note errors, rhythm errors, repetitions, and hesitations for each participant. The procedures and outcomes were socially validated through subjective evaluation by the participants and music teachers not involved with the study.

Active support: a systematic review and evidence-based practice evaluation.

Researchers have evaluated active support in agencies for persons with developmental disabilities to increase staff assistance and service user engagement. A systematic review identified two studies in which researchers reported three experimental evaluations of active support. Only one experiment showed a clear functional relationship between active support with "ineffective" to "questionable" percentage of nonoverlapping data points effect sizes and acceptable percentage of all nonoverlapping data points effect sizes. Two experiments did not show experimental control; however, there was evidence that the investigators in these studies did not sufficiently manipulate the independent variable. Based on these data, active support only meets Chambless and Hollon's (1998) criterion for a "promising treatment" but not an evidence-based practice. Future research on active support should demonstrate that the experimenter manipulated the independent variable and reported data on individual participants.

Psychometric properties of the Disability Assessment Schedule (DAS) for behavior problems: an independent investigation.

The present study employed the Disability Assessment Schedule (DAS) to assess problem behaviors in a large sample of adults with ID (N=568) and evaluate the psychometric properties of this instrument. Although the DAS problem behaviors were found to be internally consistent (Cronbach's α=.87), item analysis revealed one weak item ('Objectional habits') with item-total biserial correlation of only .20. An exploratory factor analysis revealed two main factors. The first factor consisted of items relating to disruptive/distractive problems. The second factor consisted of items relating to antisocial/delinquent problems. Disruptive/distractive problems were specifically associated with low ID level. Antisocial/delinquent behaviors were specifically associated with male gender, schizophrenia, hospital admission and troubles with police. For patients who had both disruptive/distractive problems and antisocial/delinquent behaviors, personality disorders and autism were more frequent, where as anxiety and depression were less frequent. On the basis of the obtained results, two new DAS subscales for assessing challenging behavior were proposed. Both subscales had good levels of internal consistency, as well as face and criterion validity. Overall, the new DAS subscales were shown to have acceptable psychometric properties and have therefore potential for use in both research and clinical practice.

Using behavioral skills training to promote safe and correct staff guarding and ambulation distance of students with multiple physical disabilities.

The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when staff taught new students.

Mania and behavioral equivalents: a preliminary study.

Previous research has failed to address the possibility of behavioral equivalents in people with ID and mania. The relationship between a measure of mania and possible behavioral equivalents was assessed in 693 adults, most with severe or profound ID, living in a large residential setting. The mania subscale of the DASH-II proved to be a homogenous scale, suggesting that this may be a valid measure of mania in individuals with ID. Both item and factor analyses and correlations showed that many behavioral items acceptably correlated with the mania items. There may be some challenging behaviors that are related to mania in individuals with ID. A factor analysis noted a decreased need for sleep, restlessness, agitation, and irritability as items associated with mania.

Challenging behaviors should not be considered depressive equivalents in individuals with intellectual disabilities. II. A replication study.

Previous research has proposed behavioral equivalents for depression, but evidence for behavioral equivalents has been contradictory. The relationship between a measure of depression and several proposed behavioral equivalents of depression was assessed in 693 adults living in a large residential setting. Most were adults with severe or profound intellectual disability. The frequency of language-based measures of depression was very low. A scale to assess depression was constructed based on an item analysis of a larger pool of items. Both item and factor analysis and correlations between scores on the depression scale and individual maladaptive behavior items showed little or no relationship between proposed behavioral equivalents and depression. No support was found for behavioral equivalents of depression. This replicated the findings of Tsiouris, Mann, Patti, and Sturmey (2003). Practitioners are cautioned against using maladaptive behaviors as evidence of depression in people with severe or profound intellectual disabilities.