|
| #339 Poster Session - OBM |
| Monday, May 30, 2005 |
| 12:00 PM–1:30 PM |
| Southwest Exhibit Hall (Lower Level) |
|
| 34. An Application of Behavioral Economic Principles to the Treatment of Food Selectivity |
| Area: CBM; Domain: Applied Research |
| ALLISON L. MARTIN (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Stephanie Bethke (Marcus Autism Center) |
| Abstract: Behavioral economic theories evaluate the interaction between reinforcer schedules (price) and response allocation. In the current case study, behavioral economic principles were applied to the treatment of a young male who exhibited food selectivity by type and texture. Initially, the child could choose either to consume or expel a bite of table-textured target food. The price of expelling was increased by requiring the child consume a bite of the same food prepared at a lower texture contingent on expels. The cost of expelling continued to increase, both in terms of texture and number of bites required, while the price associated with target bites remained the same. Independent observers achieved over 80% agreement for over 26% of treatment sessions. Results suggested that increasing the price of expels altered the child’s response allocation toward consumption of target bites. However, the price (texture and number of bites required) at which the child changed his response allocation differed across food types. These data are discussed in relation to economic theory, operant conditioning, and the treatment of pediatric feeding disorders. |
| |
|
| 35. Increasing Chewing Skills in Children with Feeding Problems |
| Area: CBM; Domain: Applied Research |
| KAREN RADER (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Stephanie Bethke (Marcus Autism Center), Amanda Bosch (Marcus Autism Center) |
| Abstract: Children with feeding disorders often display deficits in oral motor skills. These deficits may result in the inability to chew or insufficient chewing skills for safely swallowing higher textures. The purpose of the current study was to systematically evaluate several treatment components designed to increase chewing behavior for two children with feeding problems. In order to increase the number of chews per bite, each child was systematically trained to exhibit a chew response using a non-nutritive implement (chew tube). Following successful non-nutritive chew training, each child was trained to chew on a cutout plastic tube containing a small portion of food. Two independent observers achieved over 90% agreement on over 25% of sessions. Post training chewing increased to acceptable levels for both children. Results showed that once chewing reached acceptable levels for one food on a tube, treatment effects generalized to three novel foods in the absence of tube training. These data are discussed in relation to oral motor skill development and treatment of texture selectivity. |
| |
|
| 36. A Comparison of the Effects of Behavioral and Sensory-Integrative Treatments on the Food Consumption of Children with Pediatric Feeding Disorders |
| Area: CBM; Domain: Applied Research |
| HEATHER KADEY (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Allison Martin (Marcus Autism Center), Michele Walker (Marcus Autism Center), Stephanie Bethke (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center) |
| Abstract: A treatment comparison was conducted to evaluate the effects of sensory integration therapy versus a behavioral treatment for increasing food acceptance in two children with pediatric feeding disorders. Effects were evaluated using a reversal design. Prior to treatment, an occupational therapist evaluated each child and designed individualized sensory integration-based treatment packages. In addition, behavioral-based treatment packages were designed based on functional analysis results that suggested that each child’s inappropriate mealtime behavior was maintained by negative reinforcement. Two independent observers achieved over 80% agreement on over 21% of sessions. Results for both subjects indicated that the children’s food acceptance during the sensory integration-based treatment remained at low baseline levels; however, the children’s food acceptance significantly increased during the behavioral-based treatment. Implications for the treatment of pediatric feeding disorders and areas of future research will be discussed. |
| |
|
| 37. An Analysis of the Combined and Isolated Effects of Differential Reinforcement and Extinction on the Treatment of Multiply Maintained Food Refusal Behavior |
| Area: CBM; Domain: Applied Research |
| KRISTI MURPHY (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Heather Kadey (Marcus Autism Center) |
| Abstract: Prior research on the functional analysis of feeding problems has suggested that negative reinforcement is primarily responsible for maintaining inappropriate mealtime behavior. However, this research also suggests that feeding problems may be multiply maintained (i.e., sensitive to multiple sources of reinforcement). In terms of treatment, this brings to question the relative importance of each maintaining function for increasing food consumption. Yet to date, no studies have systematically examined this question. The current study examined the efficacy of function-based treatments for multiply maintained feeding problems, particularly with regard to the relative contribution of each maintaining variable during treatment. In addition, given that few studies have examined the effectiveness of negative reinforcement-based alternatives to escape extinction (e.g., differential negative reinforcement), a second purpose was to evaluate the effects of a negative reinforcement contingency (both with and without positive reinforcement) for increasing food consumption in the absence of escape extinction. Two independent observers achieved over 80% agreement on over 25% of sessions. Results will be discussed in terms of functional-based feeding treatments for multiply maintained food refusal, and the role of positive and negative reinforcement contingencies in the treatment of feeding problems. |
| |
|
| 38. The Examination of Constipation as an Establishing Operation for Pediatric Feeding Disorders |
| Area: CBM; Domain: Applied Research |
| PEGGY S. EICHER (St. Joseph's Children's Hospital), Merrill J. Berkowitz (St. Joseph's Children's Hospital), Paul Tokar (St. Joseph's Children's Hospital), Tara McDonough (St. Joseph's Children's Hospital) |
| Abstract: An establishing operation is any event that alters the effects of a reinforcer. The etiology of pediatric feeding disorders have been classified as organic, non-organic or a combination of the two (Budd et al., 1992). One common organic cause of feeding difficulties in infants and toddlers is gastroesophageal reflux (GER). Medical management of GER has been found to improve these children’s food consumption (Hyman, 1994). Many children referred to an outpatient clinic for the assessment and treatment of pediatric feeding disorders also present with constipation. There is some anecdotal support suggesting that increasing the frequency and consistency of the bowel movements of children exhibiting feeding difficulties may improve their food consumption and mealtime behaviors. The current study examines 1) the effects that medication has on the frequency and consistency of bowel movements in children exhibiting feeding difficulties and 2) the relationship between the frequency and consistency of bowel movements and children’s food consumption and mealtime behaviors under treatment conditions. Four children admitted to an intensive day treatment program for feeding difficulties with a history of constipation participated in the study. Results of the study and their implications will be provided. Directions for future research will be offered. |
| |
|
| 39. Evaluating Food Acceptance and Occurrence of Emesis in Two Children with Feeding Problems by Systematically Manipulating Establishing Operations |
| Area: CBM; Domain: Applied Research |
| BARBARA S. WIMBERLY (Marcus Autism Center), Cathleen C. Piazza (Marcus Autism Center), Gregory K. Reed (Marcus Autism Center), Melanie H. Bachmeyer (Marcus Autism Center), Lindsay S. Hauer (Marcus Autism Center), Deshanda Dow (Marcus Autism Center), Stephanie Bethke (Marcus Autism Center) |
| Abstract: Children diagnosed with pediatric feeding disorders often require supplemental feedings in the form of daily tube feedings to sustain their growth. As oral feedings are introduced, tube feedings may continue during the day and co-occur with oral feedings. Under these conditions, the likelihood of satiation-related effects during mealtimes may increase (e.g., decreased motivation to consume foods, increased refusal, etc.). Alternatively, reducing the overall volume of tube feedings and altering the tube-feeding schedule (e.g., to overnight feeds) may minimize satiation-related effects and increase motivation for consumption (via deprivation). This study evaluated food consumption and occurrence of physiological responses (emesis and gagging) during meals while the volume and schedule of tube feedings were systematically manipulated. During deprivation phases, the total volume of daily tube feeds was reduced (15-19%). By contrast, during satiation phases, children received tube feeds during the day, even during oral feedings. Two independent observers achieved over 80% agreement on over 20% of sessions. Results indicated no differences in children’s oral consumption across deprivation and satiation phases. However, decreases in emesis and gagging were observed under deprivation conditions. Results will be discussed in terms of the role of biologic establishing operations on the treatment of pediatric feeding disorders. |
| |
|
| 40. Systematic Evaluation of Behavioral Distress in a Young-Adult Patient with Cerebral Palsy Undergoing Post-Orthopedic Rehabilitation |
| Area: CBM; Domain: Applied Research |
| DEBORAH KRUGLAK (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Kimberly D. Bellipanni (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute) |
| Abstract: Applied Behavior Analysis methods can assist medical teams in assessing pain behaviors. Distress behaviors during rehabilitation demands may be associated with medically treatable pain or be maintained by environmental contingencies. Discriminating between these behaviors in children with neurological impairments may be challenging. Behavioral idiosyncrasies and neuromuscular impairments may mask expression of pain. Signs of pain may be inconsistent and difficult to interpret. Self reported symptoms of pain may be missed or unavailable because of physical and communication disabilities. Operationally defining and systematically measuring pain behaviors then comparing measurements across environmental situations and in relation to interventions can elucidate the nature of distress behavior.This case study describes a 23-year-old with spastic quadriplegic cerebral palsy and severe mental retardation who, after post-orthopedic surgery, exhibited distress behaviors during rehabilitation therapies. Systematic data collection and analysis across conditions differentiated behaviors associated with environmental contingencies from behaviors associated with positioning and medication changes. Throughout hospitalization, differential reinforcement decreased some, but not all, distress behaviors, indicating pain requiring medication management was present. Combining differential reinforcement with appropriate medication resulted in increased tolerance for rehabilitation demands and decreased negative behaviors. Availability of behavioral data assisted the medical and rehabilitation team in making successful treatment decisions. |
| |
|
| 41. Shaping Alternative Pain Expression in a Young-Adult Male with Traumatic Brain Injury During Rehabilitation from Orthopedic Surgery |
| Area: CBM; Domain: Applied Research |
| GINA W. BASEY (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Crystal Chappell (Kennedy Krieger Institute), Malorie Malloy (Kennedy Krieger Institute) |
| Abstract: Following orthopedic surgery, patients experience pain with movement and weight bearing. Crying, screaming, verbal complaints, and protective posturing are pain expressions that limit rehabilitation and may be exacerbated by cognitive deficits.Data will be presented on a 21-year-old male with cognitive deficits from a brain injury at age 19. These deficits appeared to intensify expression of pain and anxiety, which interfered with medical care and physical therapy. Intervention included antecedent management (systematic presentation of demands, a structured therapy schedule, rehearsal of coping strategies, distraction during painful therapies), placing yelling and verbal avoidance on extinction, and prompting deep breathing, growling, humming and counting as alternative pain expressions. Differential reinforcement of other behavior was implemented, and yelling resulted in a response cost (starting over on the task). Intervention decreased negative vocalizations, yelling and verbal avoidance from mean session frequencies of 31.7, 22.2 and 17.7, respectively, to means of 10.4, 2.8 and 7.8. When reinforcement was made contingent on the alternative pain expressions these means were 12.2, 1.7 and 7.0.Results will be discussed in relation to the impact of brain injury on pain and coping, and the importance of teaching alternative pain expressions to facilitate rehabilitation. |
| |
|
| 42. Behavioral Intervention to Shape Functional Independence in a Young Adult Male Following Traumatic Brain Injury |
| Area: CBM; Domain: Applied Research |
| JESSICA TISCHNER (Kennedy Krieger Institute), Ethan Benore (Kennedy Krieger Institute), Gina W. Basey (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute) |
| Abstract: Individuals who sustain traumatic brain injury (TBI) often develop chronic behavioral sequelae (inattention, impulsivity, poor emotional regulation, etc.). Health care providers typically advise increased supervision by family caregivers to promote safe behavior and avoid further injury. Over time, as improved ability to make safe decisions and avoid dangerous choices is demonstrated by the patient, the degree of supervision is gradually weaned to allow for more age appropriate functional independence.Data will be presented on an 18-year-old male who was referred for outpatient behavioral intervention two years post severe TBI for treatment of aggression. Behavioral assessment identified parental hypervigilance, and excessive supervision as antecedents of aggression. Treatment consisted of developing a hierarchy of increasingly independent activities. Compliance with safety rules was differentially reinforced with advancement toward greater independence and unsafe behavior was punished with temporary loss of independence. The intervention was implemented using a behavioral contract and resulted in decreased aggression as well as greater functional independence. Patient and caregiver training will be discussed along with challenges to generalization and maintenance of behavioral gains in post TBI young adults. |
| |
|
| 43. Assessing the Impact of Behavioral and Pharmacological Interventions on the Disruptive Behavior of a Child with Pre-Morbid Attention Deficits Undergoing Rehabilitation for Traumatic Brain Injury |
| Area: CBM; Domain: Applied Research |
| KIMBERLY D. BELLIPANNI (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Melissa H. Beck (Kennedy Krieger Institute), Jessica Tischner (Kennedy Krieger Institute), Shannon L. McIntyre (Kennedy Krieger Institute) |
| Abstract: Children with Traumatic Brain Injury (TBI) present challenges in rehabilitative settings. Pediatric patients often exhibit aggressive and disruptive behavior after a TBI in response to therapeutic demands and/or other environmental contingencies. Behavior Analysis can assist medical teams in identifying environmental contingencies maintaining problem behaviors and making data-based treatment decisions.Data will be presented on the disruptive behavior and compliance with rehabilitation therapy of an 11-year-old male diagnosed with TBI, microcephaly, plumbism, and ADHD-Combined type. Systematic data collection and analysis across treatment phases were used to evaluate the effectiveness of differential positive reinforcement of compliance with and without medication (i.e., Concerta). Although differential reinforcement alone decreased some but not all of the problem behaviors during rehabilitation the addition of medication resulted in further decreases in disruptive behaviors and increases in compliance across all therapies. Results will be discussed in relation to the impact of premorbid behavior problems on the probability of sustaining a TBI, developing disruptive behavioral sequalae during rehabilitation and importance of using systematic behavioral data to make treatment decisions and evaluate treatment effectiveness. |
| |
|
| 44. Measuring Outcomes of Anger Management Treatments in an Acquired Brain Injury Outreach Program Using Goal Attainment Scaling |
| Area: CBM; Domain: Applied Research |
| KELLEY D. ANSTEY (ABI Behaviour Services, West Park Healthcare Centre), Gary J. Gerber (ABI Behaviour Services, West Park Healthcare Centre), Andrew W. McNamara (George Brown College), Judy Gargaro (ABI Behaviour Services, West Park Healthcare Centre) |
| Abstract: Brain injury rehabilitation has undergone tremendous growth and development in recent years. Applied behaviour analysis is a treatment option that has increased in prominence for this client group (Ducharme, 1999; Davis & Goldstein, 1994). Applied behaviour analysis has been used to increase adaptive skills that are part of an individual’s rehabilitative goals (Grinspun, 1993; Test, Spooner, Kuel & Grossi, 1990). Such procedures have also been used to decrease maladaptive behaviours that are seen as barriers to rehabilitation (Wroblewski, Joseph, Kupfer & Kalliel, 1997; Eames & Wood 1985; Zahara & Cuvo, 1984). Difficulties with controlling and managing anger are not uncommon following moderate/severe brain injury.The authors will present data on a cohort of 31 individuals who received treatment for anger excesses. The efficacy of treatment will be examined using outcome scores on goal attainment scaling. These data will be presented to illustrate the effectiveness of ABA treatment strategies across a broad group of individuals with acquired brain injury and anger excesses. The authors will present select examples of goals and treatment strategies. The authors will discuss the implications of the data by examining commonalities among those individuals and treatments that illustrate the effectiveness of applied behaviour analysis. Additionally, the authors will present information on those individuals who left treatment to determine if they shared any common factors. |
| |
|
| 45. Behaviour Disorder and Acquired Brain Injury: An Applied Behaviour Analytic Approach Using Lag Sequential Analysis |
| Area: CBM; Domain: Applied Research |
| BARZAN RAHMAN (University of Birmingham, UK), Christopher Oliver (University of Birmingham, UK), Nick Alderman (St. Andrew's Hospital) |
| Abstract: Victims of acquired brain injured may present with severe behavioral difficulties, which can hinder effective rehabilitation. The notion that challenging behaviors may serve a functional purpose has been clearly articulated within the field of intellectually disabilities. Given the similarities in behavioral disorders exhibited by some with developmental disabilities and brain injury, it was proposed that methods of descriptive functional analysis would be applicable in the field of acquired brain injury. The aims of the study were to decipher the behavioral functions of verbal and physical aggression of three severely brain-injured patients during post-acute rehabilitative treatment. Staff members completed questionnaires and were interviewed to provide preliminary analyses of participants' behavioral repertoires. Eight hours of live observational data were collected for each participant using a handheld computer, which facilitated the recording of continuous behavior streams in real time. Time-based lag sequential analysis was conducted on the behaviors. For each participant behavioral function was evident and the streams of behavior evidenced a high degree of organization. Implications for future research and the clinical utility of the approach to inform and individualize intervention strategies are discussed. |
| |
|
| 46. Behavioral Treatment of Severe Behavior Problems of a Young Adult Male with Down Syndrome and Obsessive Compulsive Disorder Receiving Medical Care for Sleep Apnea |
| Area: CBM; Domain: Applied Research |
| SHREYA P. HESSLER (Kennedy Krieger Institute), Kristin T. Avis (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute), Leanna J. Herman (Kennedy Krieger Institute) |
| Abstract: Down Syndrome is a disorder characterized by chromosomal abnormalities that affect physical and mental development. Individuals with Down Syndrome often have co-morbid cardiac, respiratory, and/or intestinal problems, requiring frequent medical care. Because of their limitations and behavior problems medical procedures may be difficult for these patients.Data will be presented on a 20-year-old male with Down Syndrome and Obsessive-Compulsive Disorder who was treated in a Pediatric Psychology Outpatient clinic. He had a history of obstructive sleep apnea, severe tantrums, and non-compliance with caregiver instructions. Initial intervention focused on compliance with respiratory assistance for sleep apnea. The behavior necessary for wearing a positive airway pressure device was task analyzed into its component steps. Compliance with sequential steps in the task analysis was increased using differential positive reinforcement for each step completed. DRO programs were subsequently implemented to reduce several longstanding ritualistic and compulsive behaviors. Caregivers were trained using verbal instruction, modeling, behavioral rehearsal and corrective feedback.Results show clinically important medical and behavioral improvements including increased compliance, reductions in respiratory distress, tantrums, and ritualistic behavior. Behavioral gains maintained over the course of one year are documented and will be discussed in relation to parents’ skills at generalizing applications of behavior principles. |
| |
| |