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| CBM Poster Session 2 |
| Sunday, May 30, 2010 |
| 12:00 PM–1:30 PM |
| Exhibit Hall A (CC) |
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| 47. On Cognitive-Behavioral Thearpy and Token Economies: An Analysis of Two Psychosocial Treatments for Schizophrenia |
| Area: CBM; Domain: Applied Behavior Analysis |
| ABBE C. MACHI (Allegheny College), Rodney D. Clark (Allegheny College) |
| Abstract: Despite the establishment of antipsychotic medications as an effective treatment for schizophrenia, recent decades of research have demonstrated that these medications are not equally effective for all consumers. This view has prompted research on alternative treatments for the disorder, particularly cogintive-behavioral therapy (CBT) and token economies. The presnt study computed Cohen's d, a measure of effect size, for four studies, each of which was selected on the basis of several criteria. All four studies produced large effect sizes, suggesting that CBT and token economies have large effects and play an important role in the improvemnt in overall symptomology that a patient may experience. While the results support previous research, effect sizes do not account for what the principles underlying CBT and token economies are that contribute to their effectiveness; as such, a brief discussion about these principles is provided. In addition, various limitations of the study are briefly mentioned as ell as proposals for future research. |
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| 48. Effects of Feedback on Social Skills in Patients With Schizophrenia |
| Area: CBM; Domain: Applied Behavior Analysis |
| CHUNG-WON LEE (Chung-Ang University), Shezeen Oah (Chung Ang University) |
| Abstract: The goal of this study was to improve voluntary talking of patients with schizophrenia. Participants were three patients with schizophrenia at H Community Mental Health Facility in S. Korea. A-B-C-CD within subject design was adopted and voluntary talking was measured with behavioral checklist by self-reported. After baseline (A), written feedback on the frequency of voluntary talking measured in a previous day was delivered before each experimental session (B). In the next phase, written feedback on the frequency of voluntary talking measured during each session was delivered after each session ended (C). In the final phase, supervisor’s positive comments were added to the previous experimental condition (CD). Results showed that written feedback delivered both before and after session were effective in increasing the frequency of voluntary talking. However, there were no differences in the effectiveness between before and after. In addition, adding supervisor’s positive comments to the written feedback delivered after session did not show an additional effect. |
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| 49. Evaluation of the Implementation of a Developmental Screener by a Rural Pediatric Office |
| Area: CBM; Domain: Service Delivery |
| RACHEL J. VALLELEY (Munroe-Meyer Institute), Jody L. Lieske (Munroe-Meyer Institute, University of Nebraska Medical Center), Keith D. Allen (Munroe-Meyer Institute), Jennifer Kazmerski (Munroe-Meyer Institute, University of Nebraska Medical Center), Joseph H. Evans (University of Nebraska Medical Center) |
| Abstract: Screening has been recommended as an efficient tool to improve physicians’ early identification of developmental delays. Evidence suggests that when physicians refer because of a suspected developmental disability, there can be reasonable certainty that developmental delay actually exist. Dozens of Type 1 (efficacy) studies have demonstrated that the Ages and Stages Questionnaire (ASQ) is a screening measure that has relatively good sensitivity and specificity in identifying children with possible developmental delays. However, few Type 2 (effectiveness) studies have demonstrated that the ASQ actually results in increased identification of children with developmental needs in every day practice. Furthermore, we know little about the effectiveness of the ASQ in rural settings. This poster will present results on the implementation of a developmental screener by a rural pediatric office. A random sample of well-child visit medical records for five pediatricians was reviewed for infants and young children. Data collected includes rates of identification and referral for developmental delays by pediatricians during baseline, following independent implementation of ASQ, and following feedback on rates of identification and referral. Results will provide information on whether the ASQ functions as intended as well as whether performance feedback produces increased identification and referral. |
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| 50. Using Telemedicine to Provide Supervision and Feedback for Novel Procotols |
| Area: CBM; Domain: Applied Behavior Analysis |
| ROBERT N. DAVIDSON (Center for Autism and Related Disorders, Inc.), Emily Barba (Center for Autism and Related Disorders, Inc.), Katharine Gutshall (Center for Autism and Related Disorders) |
| Abstract: Telemedicine is a way to communicate information and feedback via communications technology (i.e. web cams, video phones, etc.). The field has grown quickly over the past years, having been applied to medical consultations, patient monitoring and counseling, radiology, psychiatry, and cardiology (Roine, Ohinmaa, & Haily, 2001). Especially popular is the using of telemedicine to provide services to rural areas or allowing access to clients who have very specialized disorders (Clawson, et al, 2008). Telemedicine has also been expanded to include behavioral consultation services that incorporate functional analysis (Barretto, Wacker, Harding, Lee, & Berg, 2006). The use of telemedicine can be used not only for direct client consultation, but for specialists and professors to supervise training (Smith & Skandalakis, 2005; Moorman, 2006). The current study used telemedicine to provide supervision and training to two masters level behavior analysts who were implementing a feeding protocol targeting food selectivity. Neither of the behavior analysts had prior experience with these specialized feeding protocols. The supervisor used Skype™ to communicate over 500 miles to provide direction and immediate feedback to the behavior analysts. Supervision was eventually faded out, and both behavior analysts were successful in carrying out the feeding protocol independently. |
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| 51. Interventions to Improve Pill Swallowing and Adherence in an Adolescent With Depression and Renal Disease |
| Area: CBM; Domain: Applied Behavior Analysis |
| Jessica C. Hankinson (Kennedy Krieger Institute), ADRIANNA M. AMARI (Kennedy Krieger Institute), Melissa Ann DeMore (Kennedy Krieger Institute), Leanna J. Herman (Kennedy Krieger Institute), Keith J. Slifer (The Kennedy Krieger Institute) |
| Abstract: The benefits of behavioral interventions to reduce barriers to medication adherence and to improve procedural abilities in children and adolescents with chronic medical conditions are well documented. This case demonstrates the use of stimulus shaping and fading procedures to teach pill swallowing combined with antecedent management and positive reinforcement to increase medication adherence. Reduction of barriers to adherence through improved ability to swallow pills and cognitive-behavioral therapy to decrease anxiety resulted in increased adherence with medication for depression and sleep, in this adolescent. Treatment involved graduated stimulus fading using cake decorations and candies of gradually increasing size to rehearse pill swallowing. Differential positive reinforcement with praise and social attention contingent on successive approximations of successful practice pill swallowing was implemented. Cognitive-behavioral skills training (e.g., positive self-statements) also was provided along with differential reinforcement of self-monitoring of adherence and use of coping strategies. Results demonstrate that treatment was successful in ameliorating behavioral avoidance of daily pill swallowing, increasing adherence and independence with medication treatments, and improving self-reported ratings of depressed mood. Data that support the effectiveness of the behavioral interventions to promote positive behavior change across domains are presented. The relationship between non-adherence, anxiety avoidance, and skill deficits are discussed. |
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| 52. Antecedent Management of Behavioral Distress During PRN Medication Wean in a Child With Chronic Pain |
| Area: CBM; Domain: Service Delivery |
| KIMBERLY E. BANCROFT (Helen DeVos Children's Hospital), Adrianna M. Amari (Kennedy Krieger Institute), Melissa Ann DeMore (Kennedy Krieger Institute), Keith J. Slifer (The Kennedy Krieger Institute) |
| Abstract: Pro re nata (P.R.N.) medications are prescribed for immediate symptom relief and administered when patients deem it necessary. Concerns with using P.R.N. medications in pediatrics include that symptoms must be experienced before medication is provided and there is a delay in medication request and delivery, leading to higher doses and exaggerated pain behavior (McGrath, 1990). Polypharmacy (i.e., combination of maintenance and P.R.N. medications) for chronic pain has become increasingly common in the medical literature, especially in patients with psychiatric comorbidities (Fishbain, 2005). This practice runs the risk of P.R.N. medications becoming used regularly and as a “rescue” intervention. This case describes a 13-year-old female with chronic headache pain who exhibited high levels of pain behavior, anxiety and poor participation during an inpatient interdisciplinary pain rehabilitation hospitalization, and specifically, during narcotic medication weaning. An antecedent intervention was implemented in which a P.R.N. analgesic was changed to a regular schedule during the weaning process. Antecedent management was effective in reducing the patient’s anticipatory anxiety, pain behavior and pain ratings during weaning. Other analgesics and anxiolytic were also successfully reduced or discontinued and the patient was better able to learn and apply behavioral pain and anxiety coping strategies and participate in daily activities. |
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| 53. Developmental Coordination Disorder:
a Review of Research on Co-Morbidities |
| Area: CBM; Domain: Theory |
| HO-JUN SONG (Daegu University), Su-jung Jang (Daegu University), Yu Mi Kim (Daegu University), Mihyang Choi (Daegu University), Gyeong Hee Seo (Daegu University), Hyo-Shin Lee (Daegu University) |
| Abstract: Developmental coordination disorder (DCD) is one of the types of disorders who are very often shown to children with developmental disabilities (DD) in elementary school.
Nevertheless, DCD has been largely known to have characters concomitant with developmental disorders in clinical and education settings in South Korea.
The purpose of this study was to analyze papers about coexistence with DCD and other disorders. We examined papers published from 1994 to 2009 and found 20 studies concerning DCD defined from M-ABC and DSM-IV.
The result of this study showed that DCD has co-morbidity; Overlap with ADHD, emotional behavioral disabilities (EBD), learning disabilities and language disorders.
Therefore, we need to recognize DCD as a coexisting disorder and to deal with it carefully in the early of assessment and intervention in the field of special education, even including assessment of EBD and DD. |
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| 55. The Analysis for Building Evidence-Based Practice Through Quality Indicators and the Road Map: Focus on the Study About Positive Behavior Support Intervention in South Korea |
| Area: CBM; Domain: Applied Behavior Analysis |
| YUNHEE SHIN (Daegu University), Ju yeon Yun (Daegu University), Kyung seo Kim (Daegu University), Ku Hyun Jin (Daegu University), Won OK Gu (Daegu University), Sang Bok Lee (Daegu University) |
| Abstract: The purpose of this study was to analyze papers about positive behavior support strategies(PBS) and to find the characteristics and trends.
We examined papers published from Jan. 2001 to July. 2009, and classified them according to general features, quality indicators for evidence-based practice (EBP), and the road map for EBP.
We found 19 studies concerning PBS; 17 single-subjected studies and 2 Group experimental studies.
In analysis through quality indicators for single-subject and group experimental research studies, the studies satisfied the indicator in terms of participants, variables, intervention program and observer’s reliability, but were inadequate in terms of intervention fidelity, inter validity, and quality of implementation.
The quality of data analysis was especially insufficient in the group-experimental studies. Also, there was an absence of efficacy stages and monitoring stages according to the road map for EBP.
Therefore, we discussed the research in relation to practices and suggestions for future studies were made. |
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| 56. An Evaluation of Motivating Operations Within Brief Functional Analyses |
| Area: CBM; Domain: Applied Behavior Analysis |
| PATRICK ROMANI (University of Iowa), Kelly M. Schieltz (University of Iowa), David P. Wacker (University of Iowa), Thomasin Hall (University of Iowa) |
| Abstract: The present study evaluated using functional analysis conditions as motivating operations to identify the maintaining variables of problem behavior. We will present data from two clients referred to a behavioral outpatient clinic because of behavioral concerns including noncompliance with task demands, physical aggression, and property destruction. Inter-observer agreement was collected across 30% of all sessions and averaged 90%. Each participant’s functional analysis suggested that problem behavior was maintained by access to adult attention. For the first participant, free play sessions preceding diverted attention sessions resulted in high percentages of problem behavior. Conversely, demand sessions preceding diverted attention sessions resulted in comparatively low percentages of problem behavior. These data suggested that demand sessions might have functioned to abolish motivation for attention. Similar results with a second participant showed a similar abolishing effect for a separate function (i.e., tangible). Results will be discussed in terms of their potential relevance to clinical practice. |
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| 58. Evaluating the Effects of Matched and Unmatched Stimuli on Nail Biting in Typically Developing Children |
| Area: CBM; Domain: Applied Behavior Analysis |
| ANDREA ZAWOYSKI (University of Florida), Amanda Bosch (University of Florida), Timothy R. Vollmer (University of Florida), Danielle Broome (University of Florida) |
| Abstract: Piazza, Adelinis, Hanley, Goh, and Delia (2000) found that matched stimuli were more effective at reducing stereotyped behavior for individuals with developmental disabilities; however, when Ahearn, Clark, DeBar and Florentino (2005) replicated this study, results indicated that unmatched but highly preferred stimuli were more effective at reducing stereotyped behavior. We evaluated the effects of matched and unmatched stimuli on nail biting in three typically developing children, ages five-fifteen. All sessions were conducted in the participants’ homes. Antecedent-based functional analyses were conducted to determine the condition during which participants were most likely to engage in nail biting. This condition was then used in the treatment comparison in which participants were given access to highly preferred items which did or did not match the oral, tactile, or oral and tactile stimulation provided by nail biting. We will present data demonstrating the effectiveness of these treatments to suppress nail biting. Furthermore, we will show the effects of matched and unmatched stimuli on both nail biting and task completion; preliminary data suggests that unmatched and tactile stimuli compete with task completion. We will also discuss possible extensions of this treatment to different populations and to situation in which more intensive treatments may be impractical. |
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| 59. Parent Training, Acceptance, and Mindfulness as a Pediatric Obsessive Compulsive Disorder Treatment |
| Area: CBM; Domain: Applied Behavior Analysis |
| JENNIFER YARDLEY (Utah State University), Clint Field (Utah State University) |
| Abstract: The incidence rate of pediatric OCD has been cited as affecting as many as 2% of children. CBT and CBT with medication are currently the only probably efficacious treatments for pediatric OCD. There appears to be at least two major limitations to these treatments. First, current treatments largely preempt parental involvement both within the treatment session as well as outside of sessions in the context of therapeutic homework. Thus, valuable benefits that could be gained through parental involvement have been neglected. Second, CBT and medication primarily target cognitions and overt symptomotology while neglecting hypothesized underlying processes such as psychological flexibility and individual values. Evidence now suggests that such processes may be of clinical importance. This study evaluates the effects of a 10-week protocol that emphasizes parent-child interaction as a method for facilitating treatment with child-focused acceptance and mindfulness techniques integrated across sessions. Participants are four children age 7 to 12 with obsessive compulsive disorder. A multiple baseline design will be used to evaluate treatment effects of the pediatric OCD protocol to control for the effects of time. Data to be collected. Research will show how a parent-facilitated acceptance and mindfulness-based treatment affects client functioning, symptoms, and psychological flexibility. |
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| 60. On the Impact of Environmental Variables on Obsessive Compulsive Disorder-Related Behavior |
| Area: CBM; Domain: Applied Behavior Analysis |
| CAITLIN J. SMITH (Munroe-Meyer Institute), Henry S. Roane (SUNY, Upstate Medical University), Terry S. Falcomata (University of Texas at Austin), Kasey Stephenson (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: In the current study we evaluated specific environmental variables impacting the occurrence of obsessive behaviors exhibited by an adolescent diagnosed with obsessive compulsive disorder (OCD). First, we conducted a free play condition in which only the participant and her mother were present in a therapy room baited with items that were reported to evoke the obsessive behaviors. High rates of obsessive behaviors were observed when only the participant and her mother were present in the room. Next, we implemented a condition in which a therapist joined the participant and her mother in the baited room and rates of obsessive behaviors were observed at zero rates throughout the condition. Following a series of reversals in which high rates of obsessive behavior were observed in the absence of the therapist and zero rates were observed when the therapist was present, we implemented a fading procedure in which the presence of the therapist was systematically faded from the room. The fading procedure was eventually successful as rates of obsessive behavior occurred at zero rates when only the participant and her mother were present in the room following the fading of the presence of the therapist. Results are discusses in terms of the potential environmental impact on OCD-related behavior. IOA was collected on at least 30% of all sessions and averaged over 90% agreement. |
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| 61. Evaluating Effective Treatments for Pediatric Feeding Disorders: A Review of Published Research and Data From an Intensive Home-Based Feeding Program |
| Area: CBM; Domain: Applied Behavior Analysis |
| JENNIFER LEIGH KING (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz), Nissa Wendy Goldberg (Clinic 4 Kidz), Michelle L. Waddell (Clinic 4 Kidz), Aida Miles (Clinic 4 Kidz) |
| Abstract: There is a paucity of research evaluating effective treatments for children with feeding problems. The current research in the area of pediatric feeding disorders suggests that escape extinction is an effective intervention; however, in some cases escape extinction may be necessary but not sufficient in increasing feeding skills. The purpose of this study is to evaluate the pediatric feeding disorders literature by calculating the percentage of studies using different treatment components that have been shown to be effective. In addition, data will be presented from at least 80 patients from a home-based feeding program to show what percentage of patients required different treatment components and which treatment components were necessary is resolving various feeding problems. Data suggest that 100% of the children in the sample from the home-based feeding program required escape extinction but often times escape extinction was paired with other treatment components. Data will be discussed in relation to evaluating the gaps in the pediatric feeding disorder literature and what treatment components still require more empirical data. |
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| 62. The Treatment of Food Selectivity in Children With Autism: Going Beyond Escape Extinction |
| Area: CBM; Domain: Applied Behavior Analysis |
| MICHELLE L. WADDELL (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz), Jennifer Leigh King (Clinic 4 Kidz), Nissa Wendy Goldberg (Clinic 4 Kidz), Aida Miles (Clinic 4 Kidz) |
| Abstract: Children with autism often display severe food selectivity by type (i.e., highly selective preferences for specific foods or presentations; e.g., chicken nuggets only from McDonalds, only eating crunchy foods), which can cause health risks (i.e., failure to thrive, dehydration, obesity). It is unclear why these types of preferences develop; however, research has shown that these children typically will learn to refuse nonpreferred foods by engaging in a variety of refusal behaviors (e.g., crying, pushing the food away etc.). These refusal behaviors are generally maintained by negative reinforcement in the form of escape. Therefore, escape extinction has been a viable treatment to decrease food refusal and increase consumption of different types of food. The purpose of this presentation is to evaluate case study data from children who were admitted to an intensive home-based feeding program for food selectivity. Data were collected on the number of foods consumed at different points in the treatment program. Data indicated that escape extinction alone was not effective in increasing consumption of a variety of foods and in most cases other consequence-based procedures such as reinforcement was necessary. However, in most cases antecedent-based interventions such as fading was also necessary. All participants showed an increase in the number of foods consumed relative to baseline when a treatment package was implemented. |
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| 63. Negative Reinforcement Using Previously Refused Foods as Treatment for Food Selectivity |
| Area: CBM; Domain: Applied Behavior Analysis |
| Petula Vaz (Munroe-Meyer Institute), VALERIE M. VOLKERT (Munroe-Meyer Institute), Victoria Stewart (Munroe-Meyer Institute, University of Nebraska Medical Center), Rebecca A. Groff (Munroe-Meyer Institute, University of Nebraska Medical Center), Heather J. Kadey (Munroe-Meyer Institute, University of Nebraska Medical Center), Jason R. Zeleny (Monroe-Meyer Institute, University of Nebraska Medical Center), Cathleen C. Piazza (Munroe-Meyer Institute, University of Nebraska Medical Center) |
| Abstract: Food selectivity is characterized by a preference for some foods and an excessive negative response to non-preferred foods. One potential method of capitalizing on the child’s food preferences is to use preferred and non-preferred foods as consequences for acceptance and refusal (Kelley, Piazza, Fisher, & Oberdorff, 2003). Kelley et al. compared positive- (presentation of a preferred food following acceptance of the liquid) and negative (presentation of a non-preferred food following refusal of the liquid) reinforcement-based treatments alone and in combination to treat the liquid refusal of 1 child. The 3 treatments were equally effective. The current study extended the findings of Kelley et al. by using a non-preferred food as negative reinforcement for 1 child’s food selectivity. First, we conducted a paired-choice food preference assessment to identify a preference hierarchy of the child’s non-preferred foods. We labeled the child’s least preferred food the avoidance food and the remaining foods the target foods (i.e., those foods targeted for treatment). During treatment, the feeder used escape extinction to present the avoidance and target foods if the child refused to accept the target foods. Results indicated that the avoidance procedure was effective in increasing acceptance and consumption of non-preferred target foods. |
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| 65. Behavioral Treatment of Food Selectivity and Refusal in a Typically Developing Eight-Year-Old Girl |
| Area: CBM; Domain: Service Delivery |
| VALERIE PAASCH (Kennedy Krieger Institute), Katherine Simpson Spencer (Kennedy Krieger Institute), Hannah Pennington (Kennedy Krieger Institute), Leanna J. Herman (Kennedy Krieger Institute), Adrianna M. Amari (Kennedy Krieger Institute), Keith J. Slifer (The Kennedy Krieger Institute) |
| Abstract: Food selectivity and refusal are behaviors typically seen in youth diagnosed with autism or other developmental disabilities. Although less common, these behaviors also present problems for children without disabilities and their families. Data will be presented on a typically developing 8-year-old female treated in a pediatric psychology outpatient clinic for food selectivity and refusal (chewing non-preferred food excessively before spitting it out) following an alleged traumatic event. Assessment identified parent-child mealtime interactions and highly preferred food (e.g., desserts) offered following refusals as maintaining factors. Interventions focused on compliance with food-related demands rather than food volume, given appropriate weight for age. In-session treatment involved verbal prompting, pairing preferred and non-preferred foods, distraction, contingent reinforcement, and escape extinction. Parent-implemented home interventions included shaping compliance during dinner using contingent reinforcement and mealtime rules to increase swallowing non-preferred foods. Tangible reinforcement was provided to the child for willing consumption of additional bites of non-preferred food.
Following 10 weeks of treatment, the child increased the variety of foods consumed, eliminated food refusal behaviors at home, and generalized non-preferred food consumption to all meals. Treatment continues to target increases in food preferences and general principles of behavior modification to maintain positive mealtime behaviors. |
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