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| Advances in Behavioral Assessment and Treatment of Severe Problem Behavior in Children with Biologically-Based Disorders |
| Tuesday, May 31, 2005 |
| 10:30 AM–11:50 AM |
| Stevens 2 (Lower Level) |
| Area: DDA; Domain: Applied Research |
| Chair: Patricia F. Kurtz (Johns Hopkins University School of Medicine) |
| Abstract: Neurological and genetic disorders are often characterized not only by their genotype and phenotype, but also by the presence of overt behaviors. Some neurological and genetic disorders have as a defining clinical feature the presence of severe problem behavior, such as self-injurious tongue biting associated with Lesch-Nyhan. Though the behaviors displayed by these individuals likely have a neurological/biological etiology, some research suggests that these behaviors may be equally responsive to behavioral interventions as behaviors that have been more clearly shaped by the individual’s environment. In this symposium, four applied researchers will present work related to extending behavior analysis towards the treatment of severe problem behavior exhibited by individuals diagnosed with a medical condition where behavior problems are a defining clinical feature. One presenter will describe the utility of a simplified Habit Reversal treatment to decrease SIB associated with a sensory neuropathy. The next presenter will describe the treatment of severe problem behavior in a child with CHARGE syndrome. The third presenter will describe the treatment of severe aggression associated with Cornelia de Lange syndrome. The final presentation will summarize the assessment and treatment of self-injury and other problem behaviors in a group of children with Smith-Lemli-Opitz syndrome. |
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| The Treatment of Automatically-Maintained Self-Injury in a Child with Congenital Sensory Neuropathy. |
| DAVID E. KUHN (Johns Hopkins University School of Medicine), Louis P. Hagopian (Johns Hopkins University School of Medicine), Cindy T. Terlonge (Louisiana State University) |
| Abstract: Behavioral treatments for self-injurious behavior (SIB) are generally developed based on the identified function of the behavior. Individuals whose behavior produces some change in his/her environment can learn to communicate appropriately to effect that change (e.g., FCT), or that change can be made independent of the individual’s behavior (e.g., NCR). When the contingency maintaining the behavior is hypothesized to be access to sensory stimulation, treatment options change to increasing levels of stimulation in the environment and/or implementing procedures to interrupt or prevent the behavior (e.g., protective helmet, response blocking), because the exact type of stimulation is unknown. However, for behaviors hypothesized to attenuate a painful sensation, treatment options are typically pharmacological in nature, in an attempt to reduce the pain. The current study describes a 10-year-old boy diagnosed with a Congenital Sensory Neuropathy who displayed severe SIB hypothesized to be maintained by the attenuation of a perceived itching sensation. Following a functional analysis and treatment evaluation with response blocking and competing items, a simplified Habit Reversal treatment was evaluated and found to be very effective. This treatment involved awareness training, self-monitoring, differential reinforcement, and engagement in incompatible activities. Treatment effects were generalized from 10min sessions to across the day. |
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| Behavioral Treatment of Problem Behaviors in a Child with CHARGE Syndrome |
| KYONG-MEE CHUNG (Johns Hopkins University School of Medicine), SungWoo Kahng (Johns Hopkins University School of Medicine), Anna E. Chirighin (Kennedy Krieger Institute), Kate Litman (Kennedy Krieger Institute) |
| Abstract: CHARGE is a congenital disorder and an acronym for the constellation of medical problems that define this syndrome: coloboma of the eye, heart defects, atresia of the choanae, retardation of growth or development, genital hypoplasia, and ear malformation. The number of children diagnosed with CHARGE Syndrome is increasing, and several studies have reported that children with CHARGE syndrome exhibit multiple behavioral problems (e.g., repetitive behaviors, non-compliance, and social skills deficits) and educational problems. Yet, no effective treatment has been identified for problem behaviors associated with this syndrome. In this study, principles of applied behavior analysis (ABA) were used to decrease self-injurious and disruptive behaviors for a 5-year old boy with CHARGE syndrome. The results of a functional behavior analysis indicated that SIB was maintained by sensory stimulation and access to social attention, and disruptive behavior was maintained by avoidance of task demands. 96% and 30% reductions in SIB and disruptive behavior respectively were achieved after implementation of the treatment package developed based on results from FBA. Additional application of ABA principles to other problem behaviors related to CHARGE syndrome (e.g., non-compliance wearing hearing aides, breathing mask, brushing teeth, and feeding) will be briefly discussed. |
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| Behavioral Treatment of an Adolescent Female with Cornelia de Lange Syndrome |
| MELANIE DUBARD (Johns Hopkins University School of Medicine), Louis P. Hagopian (Johns Hopkins University School of Medicine) |
| Abstract: Cornelia de Lange syndrome (CdL) is a congenital syndrome that affects 1:10,000 to 1:30,000 live births. Children diagnosed with CdL have a range of clinical features from short stature to hirsutism. They also have impairments in growth and development, speech and language, hearing, and vision; dental problems; orthopedic and gastro-intestinal problems; and behavior problems. Although self-injury is the behavior most commonly associated with CdL, 41.9% of children with CdL also have aggression on a daily basis. Julie was referred for the assessment and treatment of aggressive behavior. She also presented with social skills deficits and verbal perseverations, both of which are common to children with CdL. Treatment for Julie’s aggression consisted of a combination of medical and behavioral treatments. The behavioral intervention included differential reinforcement plus extinction and response cost, social skills training, noncontingent attention and redirection of verbalizations. This intervention resulted in an 80% reduction in behavior from baseline. Interobserver agreement data were collected for a minimum of 33% of sessions with at least 80% reliability. |
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| Assessment and Treatment of Aberrant Behaviors in Children with Smith-Lemli-Opitz Syndrome |
| JULIA T. O'CONNOR (Johns Hopkins University School of Medicine) |
| Abstract: Smith Lemli Opitz Syndrome (SLOS) is a complex genetic disorder caused by a metabolic error in cholesterol metabolism. Children with SLOS have clinical features including dysmorphic features, multiple congenital anomalies, failure to thrive and developmental delay. In addition, there are also CNS malformations including holoprosencephaly, congenital heart disease, cleft palate and renal malformations. The most common behavioral characteristics of children with SLOS include irritability, poor attention span, self-injurious behaviors and autism (Tierney, Nwokoro, Porter, Freund, Ghuman & Kelley, 2001). In the current study, 11 children with SLOS participated in behavioral assessment and treatment of problem behavior. Approximately 82% displayed self-injurious behaviors, while 54.5% displayed aggressive behaviors. A case example will be provided for one of these children, Allen. Functional analysis procedures (Iwata et al., 1982/1994) were used to determine the environmental contingencies maintaining Allen’s self-injury, aggression, and disruptive behaviors. A behavioral treatment resulted in a 96.3% reduction in problem behavior from baseline in the divided attention condition and 99% reduction in the demand situation. Interobserver agreement data were collected for a 44% of the attention sessions averaging 98% and for 32% of the demand sessions averaging 95%. |
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