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| Troubleshooting Behavioral Protocols: What to Do when the Tried and True Fail |
| Friday, November 30, 2001 |
| 1:00 PM–1:50 PM |
| Barbantini Hall |
| Area: CBM; Domain: Applied Behavior Analysis |
| Chair: William J. Warzak (University of Nebraska Medical Center) |
| Abstract: Applied behavior analysts have developed strategies to address a wide variety of clinical problems. In so doing, many behavioral approaches have become systematized, promulgated through the professional literature and disseminated through graduate training programs. Although these interventions may be tailored to the meet the needs of the individual, protocol driven interventions may be insufficient to overcome the challenges of any one patient or group of patients. These exceptions to protocol driven intervention may require analytic skills or special content knowledge not commonly available to the community clinician. This symposium addresses issues associated with troubleshooting commonly prescribed behavioral interventions that have failed. We provide examples of clinical problem solving strategies developed to overcome unusual obstacles in the assessment and treatment of children with ADHD, nocturnal enuresis, and brain injury. Each presenter will provide information related to the assessment and treatment of a selected population where standard protocols initially failed to resolve the presenting problem. Clinical procedures and specific content issues will be addressed in an effort to provide symposium participants of with clinical problem solving skills and methods we have found to be useful when dealing with refractory behavioral problems. |
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| Overcoming Obstacles to Behavioral Intervention with Brain Injured Children |
| WILLIAM J. WARZAK (University of Nebraska Medical Center) |
| Abstract: Children with brain injuries comprise a unique subset of children who often present with an assortment of behavioral and cognitive deficits that stymie family members and perplex school staff. The behavior of these children may be highly variable due to conditions surrounding their injuries and illnesses. Ongoing child development of behavioral and cognitive competencies further complicates identification of variables that shape and maintain behavioral excesses and deficiencies. For example, the simple verbal delivery of requests or commands may no longer be sufficient if the child's ability to respond to auditory stimuli, understand spoken language or retain commands over time has deteriorated. Similarly, stimuli, events, or conditions that previously served to reinforce or punish behavior may no longer be effective because of changes in cognitive abilities (i.e., changes in perceptual, sensory, or motor functioning). The functional consequences of these changes in cognitive status may not be entirely clear by virtue of behavioral assessment alone. Similarly, neuropsychological assessment may shed light upon an individual's cognitive abilities, yet not capture the depth of functional impairment suggested by structured behavioral assessment. A combination of procedures may provide the information necessary to monitor improvement, such as might result from closed head injuries, as well as deterioration, such as that seen in many neuroregressive diseases. This presentation will provide case examples of strategies for the behavioral assessment and treatment of these children that encompass both behavioral and neuropsychological data to capture target behaviors of interest and facilitate ongoing rehabilitation and treatment. |
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| Trials and Tribulations in Parent Training: Uncovering Hidden Obstacles to Effective Intervention |
| GRETCHEN A. GIMPEL (Utah State University), Hollie Bergloff (Utah State University), Angie Ehrlick (Utah State University), Marietta Veeder (Utah State University), Tobin Jones (Utah State University), Casey Johnson (Utah State University) |
| Abstract: Parent training is a commonly used intervention for children with disruptive behavior disorders including Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder. Standard parent training programs follow a basic two part model in which parents are first taught to use positive attending skills to shape adaptive behavior and then taught to implement discipline skills to reduce inappropriate behavior. Problems experienced during parent training are often due to difficulties parents have in implementing procedures correctly and consistently (e.g., not practicing skills, not attending appointments). Occasionally, though, children react in an unforeseen manner to the procedures their parents are implementing. This presentation will provide case examples of situations in which children reacted poorly to the first portion of parent training (positive attending) and the solutions developed to overcome these problems. We provide examples of situations in which children were not responsive to correctly implemented procedures as demonstrated in session. Among the case examples to be presented are a child who continually reported that he did not believe what his mother said and a child who wanted to use positive attending skills with his mother but did not want his mother to use these skills with him. Issues related to the comprehensive assessment and therapy of pediatric behavior problems will be discussed. |
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| Nocturnal Enuresis and Moisture Alarms: Troubleshooting Potential Pitfalls |
| JODI A. POLAHA (University of Nebraska Medical Center) |
| Abstract: There is a large body of empirical literature that supports the enuresis alarm as the treatment of choice for nocturnal enuresis. In some cases, however, the standard alarm protocol may be inadequate for a number of reasons ranging from the medical (e.g., bladder instability, bladder wall thickening, etc) to the behavioral (e.g., difficulty with arousal). The current paper examines the various components of a comprehensive protocol for nocturnal enuresis and the problems that may arise in conjunction with each component. Case material will be presented to illustrate potential pitfalls in this alarm procedure including complications that may arise from an inadequate assessment. In particular, this paper addresses the practical difficulties attendant to working with children who present with problems of arousal. Children who are "deep sleepers" frequently frustrate the both parents and providers alike who attempt to implement alarm procedures. Case material will highlight an intervention to facilitate arousal that uses a combination of behavioral procedures including shaping, stimulus control, and, reinforcement. Implications for the general assessment and . treatment of nocturnal enuresis will be presented. |
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