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| #250 Poster Session - CBM |
| Sunday, May 29, 2005 |
| 5:30 PM–7:00 PM |
| Southwest Exhibit Hall (Lower Level) |
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| 33. Context Manipulations and the Facilitation of Treatment Effects on the Rate of Targeted Responding |
| Area: CBM; Domain: Applied Research |
| BEN ZIMMERMAN (Kennedy Krieger Institute), Jennifer E. Dawson (Kennedy Krieger Institute) |
| Abstract: The Comparator Hypothesis (Miller and Matzel, 1989) is a paradigm that predicts specific behavior changes as a function of contextual manipulations. The paradigm predicts that the associative value of a particular stimulus or behavior is directly related to the associative value of the context in which the particular stimulus exists or behavior performed. Associative values are derived from stimulus-reinforcer pairings, behavior-reinforcer pairings, and context-reinforcer pairings. The greater the discrepancy between between the associative values of the context and the target stimulus or behavior, the greater the responding that is elicited. The present study investigates whether these findings could apply to pediatric feeding treatments in situations where targeted responding has become stagnant. Context manipulations may facilitate an increase in acceptance, as well facilitate extinction for corollary behaviors including crying, and disruptive mealtime behaviors. Preliminary data shows that a majority of participants show improved treatment effects when shifted from hospital settings to home environments. |
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| 34. Management of Behavior Outside of Mealtime: Does Anyone Want Help? |
| Area: CBM; Domain: Service Delivery |
| SUZANNE M. FUNK (Kennedy Krieger Institute), Kellie A. Hilker (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Ping Wang (Kennedy Krieger Institute) |
| Abstract: Caregivers of children attending the KKI intensive feeding program sometimes report that their children exhibit problem behavior (e.g., noncompliance, disruption, etc.) outside of mealtime. Over the course of an eight-week feeding admission, caregivers were invited to attend four lecture and discussion style groups. These groups taught caregivers various behavior management strategies including, giving instructions, compliance training, and implementing time-out. Despite much reported interest in addressing outside of mealtime behavior, attendance rates for completing the behavior management groups remained below 25%. To determine the motivational factors (e.g., incentives, scheduling, child care, etc.) influencing the caregivers’ attendance, questionnaires were administered to a group of parents attending the program. Information obtained using the questionnaire was then used to make modifications to the group in an effort to increase attendance. Modifications made to the group based on questionnaire feedback and subsequent changes in attendance will be presented. Future plans for the behavior management group will be discussed. |
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| 35. Treatment Acceptability Ratings for Parkinson's Disease-Related Depression: Initial Findings |
| Area: CBM; Domain: Applied Research |
| DUANE A. LUNDERVOLD (Central Missouri State University), Shannon Garcia (Central Missouri State University) |
| Abstract: Parkinson's disease (PD), a progressive neurological disorder, affects motor, cognitive and limbic systems. Depression occurs in up to 50% of patients. PD symptoms of "freezing," stiffness and pain are aversive. Motor dysfunction may limit access to valued behavioral activities that are reinforcers. Medication is the primary treatment for depression, though effectiveness is unclear. Behavioral Activation Treatment (BAT) for depression is effective and acceptable to caregivers and older adults with a Alzheimer's disease. However, little is know regarding the acceptability of BAT for patients with PD and comorbid depression. Thirty-one undergraduate students completed a 20-item knowledge test of PD and depression. Subsequently, they read a case description of an older adult with PD and depression followed a description medication and BAT for depression. An acceptability rating was obtained for each intervention. Order of treatments was counter balanced. Participants had moderate knowledge of PD and depression (mean 14.25, sd 2.26). Correlated t-test results indicated BAT was significantly more acceptable (mean 44/48, sd 6.92) than pharmacotherapy (mean 33/48; sd 8.66). Demographic variables were not related to acceptability ratings (r = .31, p = .09). Research comparing responses of older adults is being conducted. |
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| 36. Complex Pediatric Feeding Disorders: Child Characteristics and Treatments |
| Area: CBM; Domain: Applied Research |
| ASHLEY J. GREER (Kennedy Krieger Institute), Elizabeth A. Masler (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute) |
| Abstract: According to research surrounding chronic feeding problems, 3% to 10% of all children exhibit severe and persistent feeding difficulties, such as those that lead to feeding disorders. Feeding disorders have been reported in a variety of children, ranging in age, health status, and cognitive development and have been attributed to a variety of medical, environmental, and behavioral factors. Regardless of these variables the research has shown consistently that pediatric feeding disorders can be treated successfully using a variety of behavioral techniques including a combination of reinforcement procedures such as differential reinforcement and extinction procedures such as planned ignoring. This study identified the characteristics of children admitted to a multidisciplinary feeding disorders unit between the years 1997 and 2004. The individual components used in each child’s treatment are also reported. |
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| 37. Treatment of Bottle Dependency and Severe Food Refusal: Use of a Nuk Brush to Increase Acceptance |
| Area: CBM; Domain: Applied Research |
| MARY K. HARSH (Kennedy Krieger Institute), Nicole M. Roscoe (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute), Kellie A. Hilker (Kennedy Krieger Institute) |
| Abstract: This study examined a treatment procedure designed to increase the acceptance of solid food for a 5-year-old boy with severe food refusal. In this case, the child’s PO intake consisted of drinking a mixture of milk and formula from a specific bottle. Attempts to increase acceptance using different bottles, cups, and utensils were unsuccessful. After the child’s intake decreased to prohibitive levels, the child was admitted to an inpatient-feeding program where the medical team determined that a g-tube would be placed if the child did not begin to consume food by mouth. During the admission, several treatment procedures (e.g., reinforcement, fading, non-removal of the spoon) were implemented without an increase in acceptance. Subsequently, an additional procedure was used in which bites were presented on a Nuk brush and placed between the child's teeth and cheek. Using this procedure, the child consumed the food but was not opening his mouth upon presentation of the bite. The food was then deposited on a fixed-time interval that led to an increase in acceptance to over 80%. The Nuk procedure was generalized to the spoon presentation and several new foods were added. Implications for the use of the procedure will be discussed. |
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| 38. Pediatric Feeding Disorders: Changes in Caregiver Stress and Mealtime Perceptions Before and After Treatment |
| Area: CBM; Domain: Applied Research |
| ELIZABETH A. MASLER (Kennedy Krieger Institute), Ashley J. Greer (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute) |
| Abstract: The Parenting Stress Index (PSI) is an instrument used to assess the amount of parent stress in parent-child relationships. The Children’s Eating Behavior Inventory (CEBI) is an instrument developed to assess eating behaviors over a variety of medical and developmental disorders. Both the PSI and CEBI were administered to the caregivers of children admitted to a pediatric feeding disorders program. This study examined differences in caregivers’ scores from admission to discharge, as well as differences in scores in relation to their child’s feeding category (i.e. tube dependent, liquid dependent or food selective). Preliminary results suggest that caregivers report significantly less stress at discharge than at admission. |
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| 39. The Use of Behavioral Anger-Management Techniques to Decrease the Inappropriate Behaviors of an Individual with a Severe Behavior Disorder: A Single-Case Study |
| Area: CBM; Domain: Service Delivery |
| EMILY BURKE (Judge Rotenberg Educational Center), Nick Lowther (Judge Rotenberg Educational Center), Ed Langford (Judge Rotenberg Educational Center) |
| Abstract: The students admitted to the Judge Rotenberg Center (JRC) have usually been diagnosed with a severe behavior disorder. Typical students often have a history of severe aggressive, health-dangerous, destructive and disruptive behavior. This study will review the use of various behavioral “anger-management” techniques that were used to decelerate the inappropriate behaviors of one such student. An important first step in behavioral anger-management was ensuring that the student was familiar with the associated terminology; the tools that were used to teach this terminology will be reviewed. The student was next taught to identify the typical stimuli for inappropriate behavior. Although JRC takes a radical behaviorist approach to the treatment of inappropriate behavior, this does not preclude the teaching of covert self-management strategies. The student was taught that such strategies were to be used under particular stimulus conditions. The student also participated in a sequence of covert self-management rehearsal sessions, which included a prompt-fading component. The details and efficacy of these strategies will be reviewed. Data recording methods and methods for progress review, including discussion of behavior data with treatment professionals, as well as presentation of such data to fellow-students, will also be reviewed. |
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| 40. Food Preference Assessments for Children with Food Refusal |
| Area: CBM; Domain: Applied Research |
| PETER GIROLAMI (Kennedy Krieger Institute), Ashley J. Greer (Kennedy Krieger Institute), James H. Boscoe (Kennedy Krieger Institute) |
| Abstract: This study examined the relation between food consumption and treatment effects on the results of paired-choice food preference assessments with a child diagnosed with food refusal. Previous research has demonstrated that children admitted to an intensive feeding program exhibited low responding during food preference assessments at discharge. In this study, paired-choice food preference assessments were conducted with a 4-year-old boy diagnosed and treated for food refusal. Assessments were conducted at several points in both baseline and treatment phases and also before and after meal sessions. Implications about the use the paired-choice food preference assessment for this population will be discussed. |
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| 41. Two Methods to Increase Solid Food Volume: Impact on Mealtime Variables |
| Area: CBM; Domain: Applied Research |
| PING WANG (Kennedy Krieger Institute), Elizabeth A. Masler (Kennedy Krieger Institute), Charles S. Gulotta (Kennedy Krieger Institute), Peter Girolami (Kennedy Krieger Institute) |
| Abstract: The current study examined the relative effects of two different methods for increasing food volume (i.e., increased number of bites versus larger spoon volume) on collateral feeding behaviors (i.e., expelling, duration, swallowing). Two participants in the study were referred to the feeding program for the assessment and treatment of total food refusal A multi-element design was used randomly alternating between the two different conditions to increase volume (i.e., number of bites versus bite size). In both conditions the same feeding intervention was used and the same total volume was the same. Data was collected on percentage of swallowing, rate of refusal behavior, percentage of expels, total grams, and meal duration. A larger spoon size resulted in decreased swallowing, increased expelling, and a shorter meal duration. Results are discussed in terms of the role of establishing operations and response effort when increasing food volume with children who have food refusal. |
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| 42. Use of a Changing-Criterion Design in the Treatment of a Typically Developing 10-Year-Old with Food Refusal |
| Area: CBM; Domain: Applied Research |
| KELLIE A. HILKER (Kennedy Krieger Institute), David Elkin (University of Mississippi Medical Center) |
| Abstract: The majority of children with food refusal present at a young age and many are diagnosed with a developmental disability. The current case study outlines the treatment of a 10-year-old typically developing female presenting with a recent history of total food refusal. Initial physician consultation highlighted concerns of early onset anorexia-nervosa; however, at assessment and throughout treatment no symptoms of this disorder were present. Further assessment pointed at a potential interaction between medication side effects, gastroesophageal reflux, and mealtime consequences. A changing criterion design was implemented in both a hospital and an outpatient setting. The initial criterion was 3 servings of food per day (1 at each of 3 meals). Achieving this criterion resulted in reinforcement from a list of child-chosen preferred activities/ items. The criteria were changed at outpatient sessions when the child had demonstrated success at each level. The final criterion involved the child eating 3 servings of food across food groups at breakfast, lunch, and dinner for a total of 9 servings a day. At termination, the child was successfully eating all food presented to her at meals, the protocol was faded, and the child was maintaining growth per the normative growth curve. |
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| 43. An Analysis of Free-Time Contingencies during the Treatment of Pediatric Feeding Disorders |
| Area: CBM; Domain: Applied Research |
| TIFFANY GILMORE CLAY (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Stephanie Bethke (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Andrea L. Ridgway (Marcus Autism Center), Allison Martin (Marcus Autism Center) |
| Abstract: Prior studies have shown that negative reinforcement in the form of a brief break from task demands can be used to decrease escape-motivated problem behavior and increase appropriate behavior (e.g., compliance). This research also has shown that the inclusion of positive reinforcement during breaks can enhance the reinforcing effectiveness of free-time contingencies. In the current investigation, we applied a free-time contingency (both with and without positive reinforcement) to the inappropriate mealtime behaviors of 3 children diagnosed with feeding disorders. A combination reversal (ABAB) and multi-element design was used to evaluate the effects of treatment (with and without escape extinction). The purpose was to evaluate the relative effects of free time contingencies (negative reinforcement) with and without positive reinforcement for increasing food consumption. Independent observers achieved over 95% agreement on over 25% of the sessions. The contribution of free time contingencies during the treatment of feeding problems will be discussed. |
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| 44. Children’s Emotion Functioning as Predicted by Internalizing and Externalizing Behaviors and Peer Social Behavior |
| Area: CBM; Domain: Applied Research |
| LEIGH ANNE FAUL (University of Mississippi), Lisa Coyne (Brown University), Kimberly L. Parks (University of Mississippi), Karen Petty (University of Mississippi), Alan M. Gross (University of Mississippi) |
| Abstract: Accurate interpretation, regulation, and expression of emotion are imperative in successful communication with others (Camras et al., 1996; Schultz et al., 2000). The ability to recognize-regulate emotion has a profound impact on individuals’ behavioral responses, and thus, their adaptive functioning as early and continuing deficits are viewed as potential markers for inadequate socialization, behavior problems, and, ultimately, psychopathology (Pollak et al., 2000). Children who lack this ability are at heightened risk to misinterpret affective and behavioral cues of others, and consequently respond with maladaptive behavior. A vicious cycle emerges from the child’s ability to correctly identify environmental emotion cues, level of acceptance from peers, and resultant behavior problems. There is growing support that dispositional emotion factors, namely emotion intensity, regulation, and understanding, may heighten or attenuate maladaptive responding (Schultz, 2003), and either enhance or compromise children’s social competence. Yet the mechanisms by which this may occur are poorly understood. This study investigates the relationship between children’s ability to recognize-regulate emotion, social behavior, and peer acceptance. Participants included 170 male children (2nd- 4th grades, 8.9 years, 59% African American). Peer status, and teacher behavior ratings were IVS while emotion understanding, emotion intensity, and emotion regulation were DVS in hierarchical regressions. SES, race, and community type were examined. |
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| 45. Treating Children with Thumb- and Finger-Sucking Using Habit Reversal Combined with Parent Education Procedures and a Moisture-Sensitive Awareness Training Device |
| Area: CBM; Domain: Applied Research |
| R. GREGORY NUNN (National University), Blake Nunn (University of Wisconsin-Milwaukee) |
| Abstract: Thumb and fingersucking (thumbsucking hereafter) are probably the first habits identified by parents of young children. These problems have been shown to cause and aggravate dental and speech problems in addition to being aesthetically unappealing. Because approximately 4o% of children have these problems, a variety of interventions have been developed to treat them. The present study of 8 children evaluated the effectiveness of parents in treating their child’s thumbsucking using the Habit Reversal Treatment combined with basic child development and behaviorally-oriented parenting information, and a moisture-sensitive Awareness training device. Using a multiple baseline, across subjects design, parents learned to record their child’s frequency of thumbsucking, to identify their beliefs regarding their child’s “need” for thumbsucking, and then learned how to independently treat their child's thumbsucking using the Habit Reversal Procedures augmented by a moisture-sensitive device designed to increase the child’s and parent’s awareness of both day and nighttime thumb or fingersucking. The Habit Reversal Treatment reduced thumbsucking by about 90% at home at the end of one week, 100% at home at one-month, and by 100% at the 8 and 12-month follow-up periods. Reliability of data recording between parents was assessed at pretreatment and at 1-week and one month after treatment began. In all cases, agreement was above 80% of the intervals observed. |
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| 46. Typing Performance in the Therapeutic Workplace |
| Area: CBM; Domain: Applied Research |
| TODD W. KNEALING (Johns Hopkins University School of Medicine), Kylene Godfrey (Johns Hopkins University School of Medicine), Carolyn Carpenedo (Johns Hopkins University School of Medicine), Conrad J. Wong (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University School of Medicine) |
| Abstract: The Therapeutic Workplace is an employment-based treatment for drug addiction that uses salary for work to reinforce drug abstinence. Participants are hired and paid to work, but are required to provide drug-free urine samples to gain daily workplace access. In the present study, unemployed cocaine-dependent methadone maintenance patients received typing and keypad training. The training program was delivered using the web-based Therapeutic Workplace application. One-minute timings of training stimuli were presented that the participant had to successfully enter in order to earn productivity pay. Two different methods of presenting keyboard characters were compared in this study. One method presented keyboard characters arranged into words, the other presented those same characters in a random order. The training methods were tested both within-subjects and separately in a between-groups design. The two types of training were assessed in terms of rates of correct and incorrect characters typed, percentage correct characters typed, number of one-minute timings initiated per hour, and the amount of training time required to complete milestone steps. Individuals trained with words appeared to have better outcomes than those trained with random characters, but differences were small. |
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| 47. Behavioral Contracting and the Elimination of Enuresis in Children Ages 5-12 |
| Area: CBM; Domain: Applied Research |
| ANTHONY C. STOVER (Behavior Analysis & Therapy, Inc.), Luis Tomas (Behavior Analysis & Therapy, Inc.), Stephen P. Starin (Behavior Analysis & Therapy, Inc.) |
| Abstract: The study was conducted to determine the effects of behavioral contracts on enuresis and the latency of reduction. The results indicated that behavioral contracting was successful in the treatment of enuresis when other forms of treatment proved to be ineffective. The thinning of reinforcement maintained the extinguished behavior and a follow-up was conducted to confirm appropriate voidance behaviors. |
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| 48. The Assessment and Treatment of Mood in Persons with Traumatic Brain Injuries |
| Area: CBM; Domain: Applied Research |
| HANNA PODOLSKA (Center for Comprehensive Services, Inc.), Gerald D. Faw (Center for Comprehensive Services, Inc.), Donna Delia (Center for Comprehensive Services, Inc.), Paula K. Davis (Southern Illinois University, Carbondale), Ashton J. Robinson (Center for Comprehensive Services, Inc.), Stacey L. Small (Center for Comprehensive Services, Inc.), Ashley E. Welch (Center for Comprehensive Services, Inc.) |
| Abstract: The purpose of the current study was to examine and treat the moods of persons with traumatic brain injury. The mood of six participants was assessed over a two-week period during baseline in an attempt to identify environmental events associated with participants’ reports of good moods. In order to develop a “mood profile” for each of the participants in the study, the events impacting their moods were classified as being related to either attention, tangible, demand or sensory variables. Treatment was implemented five-to-ten minutes following a mood assessment wherein the participant rated his/her mood as being neutral or poor. It consisted of providing the participant with an environmental event from baseline that had been associated with a good mood. Closely following the treatment, another mood assessment was conducted in order to determine if providing the event improved the participant’s mood. A version of the A-B design, the repeated preintervention-postintervention design (Thyer & Curtis, 1983), was chosen to evaluate the effectiveness of treatment because it permitted the comparison of mood states assessed immediately before and after treatment. The results of the study revealed that the environmental determinants of mood could be identified and utilized to produce improvements in how individuals rate their moods. Issues related to the behavioral assessment of mood and the implications of treatment for persons with mood problems will be discussed. |
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