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| International Paper Session - Clinical Research on Remote Behavioural Consultation, Sleep Problems, and Nocturnal Enuresis |
| Tuesday, August 14, 2007 |
| 4:00 PM–4:50 PM |
| L4 Room 1 |
| Area: CBM |
| Chair: Mary Beatrice Roberts (Murdoch University) |
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| Conditioning Treatment for Nocturnal Enuresis: Mechanisms of Action and Implications for Future Research. |
| Domain: Applied Behavior Analysis |
| MICHELLE A. FORTIER (The Mayo Clinic), Michael W. Mellon (The Mayo Clinic) |
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| Abstract: This paper presentation will begin with a brief review of the evidence that establishes the urine alarm as an empirically supported treatment as indicated by several quantitative reviews of the literature. These conclusions are so robust, further validation of this behavior therapy is unproductive. The presenter will then review current knowledge of neuro-urological research that accounts for the etiology of nocturnal enuresis and for likely mechanisms of action through which the urine alarm effectively works. A brief discussion of moderators and mediators of treatment will follow to identify what psychosocial factors account for treatment effects and for whom the treatment will be most helpful. The speaker will also present a bio-behavioral model that integrates respondant and operant learning principles and neuro-urological processes that highlight those factors that contribute to nocturnal enuresis and how the urine alarm effectively treats this common childhood disorder. Finally, the speaker will review future areas of research that are hoped to push this robust treatment to higher levels of efficacy. Audience discussion will be encouraged to better understand the barriers to accessing this effective psycho-social treatment. |
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| Sleep Problems and ADHD Behaviours: A Single Case Experimental Study. |
| Domain: Applied Behavior Analysis |
| MARY BEATRICE ROBERTS (Murdoch University), David J. Leach (Murdoch University) |
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| Abstract: This study investigated the relationship between a child’s chronic sleep problems and his ADHD-related behaviours. A single case research design that involved pre and post intervention measures and a follow up after 2 weeks was utilised with a nine year old boy diagnosed with ADHD and sleep problems. The research question was, does increasing the quality of sleep of a child exhibiting ADHD-related behaviours and with considerable sleep problems, result in a decrease in ADHD-related behaviours? The sleep quality of the child was improved using a behavioural sleep intervention package including a regular bedtime routine, bedtime stimulus control and bedtime fading procedures which took two weeks to be implemented and established by the boy’s parents. Objective measures of sleep quality were taken by an actigraph (ActiTrac) worn on the wrist throughout the pre- and post-sleep intervention and during the follow-up period. Sleep quality was also measured by a sleep diary and the Albany Sleep Questionnaire. The dependent variables were (i) attention and hyperactivity as assessed by a computer program (The Test for Attention, Impulsivity and Hyperactivity in Children), (ii) the child’s on-task behaviour and vocalisations within his regular school classroom as assessed by direct observations and (iii) his typical behaviour at home as assessed by the Connor’s Behaviour Rating Scale and interviews with the child’s mother. The results showed that after increasing the quality of the boy’s sleep, his ADHD-related behaviours were markedly reduced. It is argued that lack of sleep quality may act as an establishing operation (EO) that increases avoidance behaviours and overt vocalisations at home and school. In this case reduced sleep quality may have exacerbated the behaviours that were taken as evidence of the child’s ADHD. |
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| Issues in Remotely Delivered Behavioral Consultation for Students with Autism. |
| Domain: Applied Behavior Analysis |
| SARAH RULE SALZBERG (Utah State University), Charles L. Salzberg (Utah State University) |
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| Abstract: Emerging technology now enables residents in remote locations to gain access to and even direct service from highly specialized experts who were previously unavailable to them. There are stunning examples of the benefits of technologically mediated treatment in telemedicine. In some cases, highly specialized surgeons have remotely performed delicate operations using web-based video images and very sophisticated micromanipulators. Indeed, a variety of health assessments, medical analyses and medical consults are becoming routine in some areas of clinical practice.
But what about remotely directed, behavior analytical treatment for children with severe disabilities? It turns out that behavior analytic consultation has several attributes that set it apart from most current telemedical practice and present some significant challenges.
This paper will present a case in which a behavioral consultant developed and implemented a treatment program for a young child with Autism residing in a very remote location in northern Utah in the USA. This case will be used to illustrate a multidimensional model for designing technologically mediated, behavior analytic treatment programs for children with severe disabilities. The model will address technology, staffing, coordination, contractual agreements, on-going program evaluation and revision, and cost. |
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