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Self-injurious behavior (SIB) is a chronic disorder that often begins in early childhood; however, few studies have examined the onset of SIB in young children. This preliminary study reports on the identification, assessment and observation of SIB in 32 children who had begun to engage in SIB within the previous 6 months. Participants were ages birth to 5 years and presented with or were at risk for intellectual and/or developmental disabilities. Assessment measures included parental interviews, developmental and language measures, standardized measures of problem behavior, and direct observations conducted in the home. Results indicated that for most children, SIB emerged prior to age 1 year, and multiple topographies of SIB and other problem behaviors developed in most children. Multiple measures were useful in identifying SIB and in characterizing the behavior by topography, frequency, and severity. Findings from the examination of child communication in relation to SIB were inconclusive. Results are discussed in relation to theories of SIB emergence, and previous observational studies of young children with SIB.

Many forms of psychopathology and substance abuse problems are characterized by chronic ritualized forms of avoidance and escape behavior that are designed to control or modify external or internal (i.e., thoughts, emotions, bodily sensations) threats. In this functional magnetic resonance imaging investigation, we examined amygdala reactivity to threatening cues when avoidance responding consistently prevented contact with an upcoming aversive event (money loss). In addition, we examined escape responding that terminated immediate escalating money loss and approach responding that produced a future money gain. Results showed cues prompting avoidance, escape and approach behavior recruited a similar fronto-striatal-parietal network. Within the amygdala, bilateral activation was observed to threatening avoidance and escape cues, even though money loss was consistently avoided, as well as to the reward cue. The magnitude of amygdala responses within subjects was relatively similar to avoidance, escape and approach cues, but considerable between-subject differences were found. The heightened amygdala response to avoidance and escape cues observed within a subset of subjects suggests threat-related responses can be maintained even when aversive events are consistently avoided, which may account for the persistence of avoidance-coping in various clinical disorders. Further assessment of the relation between amygdala reactivity and avoidance-escape behavior may prove useful in identifying individuals with or at risk for neuropsychiatric disorders.

Active avoidance involving controlling and modifying threatening situations characterizes many forms of clinical pathology, particularly childhood anxiety. Presently our understanding of the neural systems supporting human avoidance is largely based on nonhuman research. Establishing the generality of nonhuman findings to healthy children is a needed first step towards advancing developmental affective neuroscience research on avoidance in childhood anxiety. Accordingly, this investigation examined brain activation patterns to threatening cues that prompted avoidance in healthy youths. During functional magnetic resonance imaging, fifteen youths (ages 9-13) completed a task that alternately required approach or avoidance behaviors. On each trial either a threatening 'Snake' cue or a 'Reward' cue advanced towards a bank containing earned points. Directional buttons enabled subjects to move cues away from (Avoidance) or towards the bank (Approach). Avoidance cues elicited activation in regions hypothesized to support avoidance in nonhumans (amygdala, insula, striatum and thalamus). Results also highlighted that avoidance response rates were positively correlated with amygdala activation and negatively correlated with insula and anterior cingulate activation. Moreover, increased amygdala activity was associated with decreased insula and anterior cingulate activity. Our results suggest that nonhuman neurophysiological research findings on avoidance may generalize to neural systems associated with avoidance in childhood. Perhaps most importantly, the amygdala/insula activation observed suggests that threat-related responses can be maintained even when aversive events are consistently avoided, which may account for the persistence of avoidance-coping in childhood anxiety. The present approach may offer developmental affective neuroscience a conceptual and methodological framework for investigating avoidance in childhood anxiety.

Forming new knowledge based on knowledge established through prior learning is a central feature of higher cognition that is captured in research on stimulus equivalence (SE). Numerous SE investigations show that reinforcing behavior under control of distinct sets of arbitrary conditional relations gives rise to stimulus control by new, derived relations. This investigation examined whether frontal-subcortical and frontal-parietal networks known to support reinforced conditional relations also support derived conditional relations. Twelve adult subjects completed matching-to-sample (MTS) training with correct/wrong feedback to establish four trained conditional relations within two distinct, three-member stimulus classes: (1) A1-->B1, B1-->C1 and (2) A2-->B2, B2-->C2. Afterwards, functional neuroimaging was performed when MTS trials were presented involving matching two identical circles (a sensorimotor control condition), trained relations (A-->B, B-->C), and derived relations: symmetry (B-->A, C-->B), transitivity (A-->C), and equivalence (C-->A). Conditional responding to trained and derived relations was similarly correlated with bilateral activation in the targeted networks. Comparing trained to derived relations, however, highlighted greater activation in several prefrontal regions, the caudate, thalamus, and putamen, which may represent the effects of extended training or feedback present during imaging. Each derived relation also evidenced a unique activation pattern. Collectively, the findings extend the role of frontal-subcortical and frontal-parietal networks to derived conditional relations and suggest that regional involvement varies with the type of derived conditional relation.

Functional magnetic resonance imaging (fMRI) is used to study brain function during behavioral tasks. The participation of pediatric subjects is problematic because reliable task performance and control of head movement are simultaneously required. Differential reinforcement decreased head motion and improved vigilance task performance in 4 children (2 with behavioral disorders) undergoing simulated fMRI scans. Results show that behavior analysis techniques can improve child cooperation during fMRI procedures.

This paper summarizes a conference held at the National Institute of Child Health and Human Development on December 6-7, 1999, on self-injurious behavior [SIB] in developmental disabilities. Twenty-six of the top researchers in the U.S. from this field representing 13 different disciplines discussed environmental mechanisms, epidemiology, behavioral and pharmacological intervention strategies, neurochemical substrates, genetic syndromes in which SIB is a prominent behavioral phenotype, neurobiological and neurodevelopmental factors affecting SIB in humans as well as a variety of animal models of SIB. Findings over the last decade, especially new discoveries since 1995, were emphasized. SIB is a rapidly growing area of scientific interest to both basic and applied researchers. In many respects it is a model for the study of gene-brain-behavior relationships in developmental disabilities.

We describe a Master's program in Applied Behavior Analysis that involves collaboration between an academic graduate program in psychology and the departments of an institution dedicated to the delivery of behavioral services: in this instance, the University of Maryland, Baltimore County, and the Kennedy Krieger Institute of the Johns Hopkins University School of Medicine. The launching of a new program and its subsequent maintenance involves a variety of contingencies, both academic and professional. This paper discusses a few of them, and demonstrates how quickly and effectively progress can be made when compatible and reciprocal contingencies of support are identified for all of the various participants in a program. As we enter the Decade of Behavior, we hope this program will provide a source of more practitioners of applied behavior analysis, so sorely needed to meet the growing demand for our demonstrably successful interventions. ********** One hallmark of behavior analysis and one source of its success in interventions is its recognition of multiple causation in the determination of complex behavior. Multiple causation operates, for example, in verbal behavior, as when the order that someone places at a fast food restaurant is simultaneously determined by many different variables: the person behind the counter as an audience, the menu as an occasion for textual behavior, the food visible in pictures and on the trays of other customers as an occasion for tacting, the overheard orders of other customers as an occasion for echoic behavior, the factors that make the food to be ordered reinforcing as establishing operations, and so on. When many variables that each occasion the same verbal response come together at one time, the verbal behavior that follows may be virtually inevitable. It is no surprise that many causes also enter into institutional behavior, and because much of our own activity as behavior analysts occurs in institutional settings, it may be useful to explore the multiple causation that may be involved in the creation and maintenance of behavior analytic programs. History It is difficult to pinpoint just when discussions began about a possible collaborative program involving the Department of Psychology at the University of Maryland, Baltimore County (UMBC) and the Kennedy Krieger Institute of the Johns Hopkins University School of Medicine (KKI); they may go back two decades or more. Some of the more recent and key administrative discussions (within the past five years) involved A. Charles Catania at UMBC, the chair of the Department of Behavioral Psychology at KKI, Michael F. Cataldo, and the chair of the UMBC Department of Psychology, Carlo DiClemente. Once agreement had been reached about the desirability and feasibility of the program and the nature of its administration, Wayne W. Fisher and A. Charles Catania undertook the implementation of the program, with special attention to design of courses and professional training. The mutual interests of all participants quickly became evident. They included but were not limited to the following: The growing field of applied behavior analysis called for more well-trained practitioners; the UMBC administration wanted to expand the enrollment of graduate students, especially at the Master's level; and, the behavior analysts at KKI needed more qualified people to staff inpatient treatment units and wanted more opportunities to interact with students of behavior analysis. The collaborative program was approved by the UMBC Department of Psychology during the 1997-1998 academic year, and the call for applications went out late in Spring 1998 with a July 1 deadline. Under those circumstances, the numbers were of course too small to really constitute a class, and a couple of students who were unable to complete applications in time were provisionally admitted to course work as special students. More standardized application procedures brought in four more students in the 1999-2000 academic year (including one student from Iceland) and six more in the current (2000-2001) academic year. …

Use of animal models can increase scientific understanding of and clinical/educational intervention possibilities for persons with mental retardation. Information gathered through such models has provided an important foundation for both theory and practice. Progress in understanding and ameliorating intellectual disability through animal modeling will be enhanced by efforts to increase the validity of the models. That is, the models must capture not merely important behavioral/cognitive processes per se, but also processes that may be especially impaired in intellectual disability. The authors reviewed criteria for determining that a given individual has an intellectual disability, selected examples of research on animal behavior that have contributed to effective prevention and treatment approaches, and successful approaches for modeling behavioral retardation. Animal models using behavioral measures based on characteristics that discriminate human mental retardation may prove to provide the most valid and clinically relevant approach. © 1997 Wiley-Liss, Inc.

In this investigation, 20 clients with mental retardation and destructive behavior disorders were treated with psychotropic medication based on symptoms associated with a psychiatric disorder. For each patient, single-case design and direct observation procedures were utilized to evaluate outcome. Three clients (15%) showed at least a 50% reduction in destructive behavior; seven (35%) experienced a 50% or greater increase in destructive behavior; 10 (50%) experienced no change in their destructive behavior. The best response was to stimulant medications prescribed on the basis of pervasive hyperactivity and distractibility. The worst response was to lithium prescribed on the basis of manic-like symptoms (e.g., psychomotor agitation) or cyclical behavior disturbance. The low response rate was hypothesized to be a function of the unique underlying brain dysfunction in severely to profoundly retarded individuals with destructive behavior disorders, and the difficulties with applying psychiatric diagnoses in the population. Given the individual variability of response among clients and the prevalence of behavior dysfunction of the population, single-case methodology may have a useful role in the assessment of psychopharmacotherapy with individuals with severe to profound mental retardation and destructive behavior disorders.

Attention-deficit/Hyperactivity Disorder (ADHD) is a developmental disorder which, by current definition, has onset prior to age 7 years. MRI studies have provided some insight into brain differences associated with ADHD, but thus far have almost exclusively focused on children ages 7 years and older. To better understand the neurobiological development of ADHD, cortical and subcortical brain development should be systematically examined in younger children presenting with symptoms of the disorder. High resolution anatomical (MPRAGE) images, acquired on a 3.0T scanner, were analyzed in a total of 26 preschoolers, ages 4–5 years (13 with ADHD, 13 controls, matched on age and sex). The ADHD sample was diagnosed using DSM-IV criteria, and screened for language disorders. Cortical regions were delineated and measured using automated methods in Freesurfer; basal ganglia structures were manually delineated. Children with ADHD showed significantly reduced caudate volumes bilaterally; in contrast, there were no significant group differences in cortical volume or thickness in this age range. After controlling for age and total cerebral volume, left caudate volume was a significant predictor of hyperactive/impulsive, but not inattentive symptom severity. Anomalous basal ganglia, particularly caudate, development appears to play an important role among children presenting with early onset symptoms of ADHD.

Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children's depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children's health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children's health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.

In reinforcer-selective transfer, Pavlovian stimuli that are predictive of specific outcomes bias performance toward responses associated with those outcomes. Although this phenomenon has been extensively examined in rodents, recent assessments have extended to humans. Using a stock market paradigm adults were trained to associate particular symbols and responses with particular currencies. During the first test, individuals showed a preference for responding on actions associated with the same outcome as that predicted by the presented stimulus (i.e., a reinforcer-selective transfer effect). In the second test of the experiment, one of the currencies was devalued. We found it notable that this served to reduce responses to those stimuli associated with the devalued currency. This finding is in contrast to that typically observed in rodent studies, and suggests that participants in this task represented the sensory features that differentiate the reinforcers and their value during reinforcer-selective transfer. These results are discussed in terms of implications for understanding associative learning processes in humans and the ability of reward-paired cues to direct adaptive and maladaptive behavior.

He dwelt no place, and gathered to himself neither wealth nor followers. Warm and eager was his spirit opposing the fire that devours and wastes with the fire that kindles and succors; but only those that knew him well glimpsed the flame that was within. Merry he could be, and kindly to the young and simple; and yet quick at times to sharp speech and the rebuking of folly; and thus far and wide he was beloved among all those that were not themselves proud. Mostly, he would at times work wonders among them, loving especially the beauty of the fire; and yet such marvels he wrought mostly for mirth and delight, and desired not that any should hold him in awe or take his counsels out of fear. (A very liberal adaptation describing Gandalf in J. R. R. Tolkien's Lord of the Rings)

Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behaviour (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, "escape extinction" was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.

Background Many human neuroimaging investigations on recognition memory employ verbal instructions to direct subject's attention to a stimulus attribute. But do the same or a similar neurophysiological process occur during nonverbal experiences, such as those involving contingency-shaped responses? Establishing the spatially distributed neural network underlying recognition memory for instructed stimuli and operant, contingency-shaped (i.e., discriminative) stimuli would extend the generality of contemporary domain-general views of recognition memory and clarify the involvement of declarative memory processes in human operant behavior. Methods Fifteen healthy adults received equivalent amounts of exposure to three different stimulus sets prior to neuroimaging. Encoding of one stimulus set was prompted using instructions that emphasized memorizing stimuli (Instructed). In contrast, encoding of two additional stimulus sets was prompted using a GO/NO-GO operant task, in which contingencies shaped appropriate GO and NO-GO responding. During BOLD functional MRI, subjects completed two recognition tasks. One required passive viewing of stimuli. The second task required recognizing whether a presented stimulus was a GO/NO-GO stimulus, an Instructed stimulus, or novel (NEW) stimulus. Retrieval success related to recognition memory was isolated by contrasting activation from each stimulus set to a novel stimulus (i.e., an OLD > NEW contrast). To explore differences potentially related to source memory, separate contrasts were performed between stimulus sets. Results No regions reached supralevel thresholds during the passive viewing task. However, a relatively similar set of regions was activated during active recognition regardless of the methods and included dorsolateral and ventrolateral prefrontal cortex, right inferior and posterior parietal regions and the occipitoparietal region, precuneus, lingual, fusiform gyri and cerebellum. Results also showed the magnitude of the functional response in the occipitoparietal region was inversely correlated with reaction times (RTs), such that the largest functional response and slowest RTs occurred to Instructed stimuli and the smallest functional response and fastest RTs occurred to GO stimuli, with effects to NO-GO stimuli intermediate. The inverse relation was also present bilaterally in the parahippocampus and hippocampus. Comparisons between stimulus sets also revealed regional differences potentially related to source memory. Conclusion Recognition of stimuli previously associated with instructions and operant contingencies (i.e., discriminative stimuli) generally recruited similar inferior frontal and occipitoparietal regions and right posterior parietal cortex, with the right occipitoparietal region showing the largest effect. These findings suggest domain-general views of recognition memory may be applicable to understanding the neural correlates of control exerted by discriminative stimuli and suggest declarative memory processes are involved in human operant behavior.

Results of numerous human imaging studies and nonhuman neurophysiological studies on "reward" highlight a role for frontal, striatal, and thalamic regions in operant learning. By integrating operant and functional neuroimaging methodologies, the present investigation examined brain activation to two types of discriminative stimuli correlated with different contingencies. Prior to neuroimaging, 10 adult human subjects completed operant discrimination training in which money was delivered following button pressing (press-money contingency) in the presence of one set of discriminative stimuli, and termination of trials followed not responding (no response-next trial contingency) in the presence of a second set of discriminative stimuli. After operant training, subjects were instructed to memorize a third set of control stimuli unassociated with contingencies. Several hours after training, functional magnetic resonance imaging was performed while subjects viewed discriminative and control stimuli that were presented individually for 1,500 ms per trial, with stimulus presentations occurring, on average, every 6 s. Activation was found in frontal and striatal brain regions to both sets of discriminative stimuli relative to control stimuli. In addition, exploratory analyses highlighted activation differences between discriminative stimuli. The results demonstrate the utility of coupling operant and imaging technologies for investigating the neural substrates of operant learning in humans.

Background Anxiety is relatively common in depression and capable of modifying the severity and course of depression. Yet our understanding of how anxiety modulates frontal and limbic activation in depression is limited. Methods We used functional magnetic resonance imaging and two emotional information processing tasks to examine frontal and limbic activation in ten patients with major depression and comorbid with preceding generalized anxiety (MDD/GAD) and ten non-depressed controls. Results Consistent with prior studies on depression, MDD/GAD patients showed hypoactivation in medial and middle frontal regions, as well as in the anterior cingulate, cingulate and insula. However, heightened anxiety in MDD/GAD patients was associated with increased activation in middle frontal regions and the insula and the effects varied with the type of emotional information presented. Conclusions Our findings highlight frontal and limbic hypoactivation in patients with depression and comorbid anxiety and indicate that anxiety level may modulate frontal and limbic activation depending upon the emotional context. One implication of this finding is that divergent findings reported in the imaging literature on depression could reflect modulation of activation by anxiety level in response to different types of emotional information.

Magnetic resonance imaging is a promising technological advance used for research and diagnosis of disease. The procedure has no risks, except when uncooperative patients require sedation. Four normal children participated in simulated scans to study the effects of (a) antecedent changes in the imaging environment and (b) operant conditioning of movement inhibition. Changing the environment can decrease movement, but operant contingencies were necessary to decrease movement to a level that, in most cases, would allow the procedure to occur without sedation.

Pediatric feeding disorders are estimated to occur in as many as one in every four infants and children, and when serious can require numerous, costly and sustained interventions. For over a decade research has cumulated evidence on the contributions of Behavior Analysis in understanding and remediating some types of pediatric feeding disorders. The systematic use of this body of evidence in conjunction with other approaches (medical, nutrition, occupational therapy, physical therapy, and so forth) is being carried out on an inpatient treatment unit at the Kennedy Krieger Institute. Key aspects are described here, including direct observation behavior assessment, approaches for increasing and decreasing feeding behavior, skill acquisition, transfer of treatment gains, and parent training. The results based on case studies and overall program evaluation indicate that medically complicated, severe feeding disorders can be treated successfully in a few months with a multidisciplinary approach which incorporates behavioral procedures.

An Importance, Locus and Range of Activities Checklist, designed to assess self-perceived latitude of choice, a self concept and a life satisfaction scale were administered to 25 institutionalized and 25 noninstitutionalized elderly females. The checklist contained statements about 37 activities of daily living which subjects rated for personal importance and degree of choice available to them. The derived latitude of choice score was based jointly on importance and choice ratings for each activity. Institutionalized respondents, living in a relatively restrictive environment, earned significantly lower latitude of choice scores than did noninstitutionalized subjects. Latitude of choice, self concept and life satisfaction scores were significantly correlated. These findings attest to the appropriateness of the technique used to assess perceived latitude of choice. Modifications of the Importance, Locus and Range of Activities Checklist designed to provide a more profound measure of latitude of choice and to improve the applicability of the scale to different categories of respondents were discussed.

This study empirically tests three theoretical approaches to explaining specific support for a policy output among members of its target group. The utilitarian model posits support as a function of objective costs and benefits to the individual stemming directly from the policy. The attitudinal model relates specific support to diffuse predispositions rooted in socialization. The perceptual model holds that specific support derives from beliefs about the character of the political decision process by which the policy was formulated. Tests of these three approaches are based on survey data on specific support for school district desegregation plans among a large sample of black and white parents of public school children in Florida. In both subsamples, the utilitarian approach explained very little of the variance in support, but the attitudinal and perceptual models were corroborated. Implications of these findings are drawn for desegregation policy making and for public policy theory.

The popularity and reported success of biofeedback treatment for neuromuscular disorders has occurred despite a lack of research identifying the critical variables responsible for therapeutic gain. In this study, we assessed the degree to which severe neurological dysfunction could be improved by using one of the components present in all biofeedback treatment, contingency management. Three cases of orofacial dysfunction were treated by reinforcing specific improvements reliably detectable without the use of biofeedback equipment. The results showed that contingency management procedures alone were sufficient to improve overt motor responses but, unlike biofeedback treatment, did not produce decreases in the hypertonic muscle groups associated with the trained motor behavior. The findings suggest that sophisticated, expensive biofeedback equipment may not be necessary in treating some neuromuscular disorders and that important clinical gains may be achieved by redesigning the patient's daily environment to be contingently therapeutic, rather than only accommodating the disabilities of the physically handicapped.

Two experiments are reported in which the relationship between compliance with "do" and "don't" requests was examined with developmentally disabled children. In Experiment 1, a multiple baseline design across subjects with counterbalanced treatment conditions was used to evaluate a compliance training program composed of four phases: (a) baseline, during which no consequences were delivered for compliance, (b) reinforcement for compliance with one targeted "do" request, (c) reinforcement for compliance with one targeted "don't" request, and (d) follow-up with reinforcement on a variable ratio schedule for compliance with any "do" or "don't" request. Results of probes conducted before and after training within each condition indicated that generalized compliance occurred only with requests of the same type as the target exemplar ("do" or "don't"). In Experiment 2, these results were replicated in a classroom setting. Following collection of baseline probe data on student compliance, a teacher training program was successfully implemented to increase reinforcement of compliance first with one "do" and subsequently with one "don't" request of a target student. Results of multiple baseline probes across "do" and "don't" requests indicated that the teacher generalized and maintained reinforcement of compliance with other requests of the same type and to other students, with a resulting increase in student compliance with the type of requests reinforced. The impact of treatment on both teacher and student behavior was socially validated via consumer ratings. Implications of these findings with respect to response class formation and compliance training programs are discussed.

This paper reviews 33 individual case or group studies describing the application of behavior therapy techniques to the management of 41 electively mute children. Management strategies included stimulus fading, reinforcement, stimulus fading plus reinforcement, and escape or avoidance procedures. Reinforcement procedures proved most effective when a minimum operant level of speech existed in the treatment setting. In the absence of baseline speech, stimulus fading procedures were successful in transferring speech stimulus fading procedures were successful in transferring speech from settings in which the child spoke comfortably, to new individuals and situations. Response cost contingencies improved the efficacy of both reinforcement and stimulus fading plus reinforcement procedures. Among the 37 cases reporting individual observations at treatment termination, 57% (21) spoke spontaneously and 43% (16) responded to prompts or questions. Follow-up observations on 32 individual cases over intervals ranging ...

A combination of a reversal design and a multiple-baseline design across settings and tic behaviors was employed to determine the effectiveness of a treatment package consisting of self-monitoring, external reinforcement, and timeout in the control of a hyperactive child's multiple tic behaviors. In the clinic the treatment package was applied only to facial tics, with three other tics (shoulder shrugging, rump protrusion, and a vocal tic) observed but never treated. At home facial tics were initially treated, and then vocal tics. Shoulder shrugging, rump protrusion, and “other tics” were never directly treated. Treatment was effective in decreasing the occurrence of facial tics in the clinic to zero. Even though no intervention was placed on the other tics, they also decreased in frequency concomitant with the facial tics. The home data also demonstrated a decrease to zero when the treatment package was sequentially applied to facial and vocal tics, with a concomitant decrease in the untreated tic behaviors. A 32-week follow-up showed maintenance of the treatment effects.

Lead poisoning, a serious problem that can result in permanent neurological damage, often results from the ingestion of inedible substances that contain lead. The behavior of ingesting nonedible substances in termed pica. In this study, behavior modification procedures were used to eliminate pica in three young children with lead poisoning. Three kinds of procedures were used: (1) discriminate training, in which the subject was taught to recognize that paint and several objects were not edible; (2) reinforcement for the absence of pica; and (3) overcorrection for the occurence of pica. Pica was eliminated in all three subjects. While it was not always clear which component of the treatment was responsible for the decrease, the sequence used had the advantage of an effictive clinical technique proceeding from least to progressively more restrictive procedures.

Scientific and public interest in the effects of diet on behavior disorders has recently increased. This paper argues that (1) the experimental analysis of behavior offers an effective scientific methodology for assessing the effects of dietary substances on behavior problems, and that (2) such analysis permits behavioral consequences to be considered as an alternative treatment to dietary control. A case study of a 9-year-old retarded boy with autistic behaviors is presented. Suspected dietary substances were demonstrated not to be effective influences on the child's behavior, whereas a simple behavior modification program improved his problem behaviors. Also discussed are issues and problems which arise in research on dietary effects on behavior and in selection of effective and ethical treatments.

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.

Epilepsy represents a serious medical and social problem. In the majority of cases, seizures are successfully managed by a variety of anticonvulsant medications, even though these drugs may potentiate significant physical and developmental side effects. A small group of studies to date have offered evidence that behavioral procedures can successfully manage some seizure disorders and are particularly desirable treatment choices when seizure disorders are intractable to drug management or when drug side effects are to be avoided. The present case adds to this small but growing group of studies in that it demonstrates the use of behavioral procedures in the analysis and treatment of high-rate myoclonic seizures. Seizures were evaluated on a hospital ward and in a controlled experimental setting. The data indicated a variable rate of seizures across days and activities and a reduction of seizure frequency in the controlled setting when time-out was made contingent on seizures. A program of “contingent rest” was then applied on the hospital ward that demonstrated a reduction in myoclonic seizure frequency and the apparent prevention of several grand mal episodes. An observer calibration procedure showed high correspondence between behaviorally and physiologically recorded seizures. A discussion of issues in behavioral medicine research follows.

Analyses of response relationships offer the potential for designing treatment procedures that are more economical and entail less risk for misuse than many we currently employ. The present study investigated whether previous results indicating the reduction of problem behaviors by reinforcing compliance in fact occurred because of the contingent relationship between compliance and the presumed reinforcing events. A clinic analogue procedure consisting of a standard set of adult requests was employed in a multiple baseline design across subjects with three children receiving three conditions — no reinforcement, noncontingent reinforcement, and reinforcement contingent on compliance — and a fourth child receiving the first and third conditions to assess possible order effects. The data indicated that: (1) compliance covaried inversely with some, but not all, of the problem behaviors measured; (2) sustained covariation occurred only when reinforcement was contingent on compliance; (3) substantially large but transient increases in compliance and decreases in problem behavior during noncontingent reinforcement occurred for those children who initially demonstrated high compliance and low levels of aberrant behavior during baseline; and (4) the problem behaviors that inversely covaried with compliance were idiosyncratic across children. The results suggest that treatment procedures based on response relationship strategies should consider that children's individual learning histories may determine which behaviors covary and the likelihood that large, initial changes can occur with noncontingent reinforcement.

The successful use of operant procedures to alter behaviors associated with various medical conditions suggests that such behaviors may be learned and that the principles of learning may be applied not only to treatment but also to the study of the pathogenesis of illness behavior. The present study, conducted within an ongoing neuromuscular research project, assessed the covariation of behaviors associated with chronic pain within and across behavioral and drug approaches to treatment. Problems of screaming and five other behaviors (including self-reports of pain) were measured across conditions of varying behavioral contingencies (noncontingent reinforcement vs the removal of reinforcement contingent upon screaming) and varying administration (time since medication and dosage) of Parsidol during attempts to treat the muscle pain of a 24-year-old male with a severe, chronic neuromuscular disorder diagnosed as dystonia musculorum deformans (DMD). Results indicated that: (a) pain behaviors covaried during behavioral and drug conditions even though the behavioral intervention only targeted screaming; (b) effects were greater on nontargeted behaviors during periods that followed rather than preceded drug administration; (c) in contrast to behavioral observation data, physiological measures of neuromuscular activity (EMG) did not differ across conditions. These results suggest that functional response-response relationships exist in patients as the result of their illness experience.

In the Person-Environment (P-E) Congruence model, psychological well-being is proposed to be a function of the degree of fit between the perceived environment and the important needs of the individual; and, that in more restricted environments, the relationship is stronger. The present study examined, cross-sectionally and longitudinally, the Congruence levels and well-being of elderly veterans (N = 165) in four microenvironments within a single instutition. Congruence was assessed using the multidimensional Environmental Perception, Preference and Importance Scale (EPPIS). Well-being was measured using the PGC Moral Scale, the Life Satisfaction Index A and a semantic differential self-concept scale. There were significant microenvironment differences on three of the 15 EPPIS dimensions; the P-E Congruence scores were predictive of well-being; and, the specific dimensions predictive of well-being varied across microenvironments, criterion of well-being and time. The data reinforces the notion that treatment programs must be individualized and that the P-E model, operationalized in the EPPIS, may serve as a viable clinical tool.

Self-injurious behavior has presented a clinical and academic challenge to both behavioral and biomedical researchers. Recent advances in biomedical research suggest a number of specific biological bases for self-injury. This research was reviewed with regard to the possibility that a specific biological explanation for self-injury could be advanced. Deficiencies in biochemicals necessary for normal brain functioning, inadequate neurological development of the central nervous system, isolation and pain related experiences early in development, altered neurological input particularly sensory irritation, neurological insensitivity to pain, and the body's ability to produce opiate-like substances (endogenous opiates) in response to pain and injury all offer leads as to the biological basis of self-injurious behavior. No single explanation has been definitively proven as a cause for self-injury in the retarded. However, consideration of behavioral treatment approaches in combination with biological explanations, especially those related to the biochemistry of pain, may provide the opportunity for important breakthroughs in the understanding and successful elimination of self-injurious behavior.

A reversal design was utilized in which differential vs non-differential adult attention was made contingent upon the delusional speech of an 11-yr-old boy. Within this design, effects of verbalizing the contingency and the use of a pharmacological treatment were also studied. The results indicated that differential adult attention only to appropriate task related statements increased such statements while decreasing delusional speech, whereas non-differential attention to any type of statement resulted in a predominance of delusional speech. A trial of methylphenidate showed no difference relative to non-differential attention. Additionally, the results suggest that verbalizing the differential attention contingency may be an effective tactic for rapid behavior change. The results are discussed in relation to the necessity for comparing possible courses of treatment as a strategy for insuring effective treatment.

Three subjects diagnosed as having severe choreoathetoid cerebral palsy were trained in the use of EMG feedback procedures. Both between- and within-session controls, including reversals of baseline, attempted muscle control with feedback, and muscle control without feedback, were employed to analyze the contribution of feedback procedures to improvements in muscle control. The data (1) indicate that feedback enhanced muscle control and (2) provide evidence of generalization of feedback effects to no-feedback conditions and untrained muscles.

Recent clinical reports have suggested that electromyographic feedback offers promise as a palliative therapy for neuromuscular disorders. This study utilized a single-subject experimental analysis to evaluate the effects of EMG feedback training on a 20-year-old man with adult-onset idiopathic dystonia to achieve control of orofacial dysfunctions. Feedback training produced reductions in levels and variability of tension in facial and forearm muscles, as measured by EMG. Reliable blind observations of facial control indicated that feedback training enabled the patient to produce normal facial relaxation in extraclinical environments.

A totally voluntary plasmapheresis program recruits 900 individual donors per year at a cancer research institute, where 500 to 900 units of platelets are transfused each month. Staff and donors use a film and brochures to recruit donors from the local community. Television and radio spots, with donor recognition pins, certificates, receptions, and picnics are utilized. Donor motivation was studied by use of: 1) California Psychological Inventory-measures a variety of “normal” personality traits; 2) Study of values—measures theoretical, economic, aesthetic, social, political, religious values; 3) Internal-External Control Scale—measures degree to which a person blames self vs. external events for what happens to him; 4) Faith in People Scale—measures individual's confidence in his fellow man; 5) Anomia Scale—measure of feelings of self-to-others alienation; 6) Mach IV Scale—measure of persons tendency to manipulate others; and 7) Biographical Data Form. Results are presented for 25 male donor subjects studied, as they compare with normative data for the scales used. Donors appeared to have the same traits as do the general population, but appeared lower in Machiavellianism than non-plasmapheresis donors. Prospective study plans include additional subjects to provide appropriate control groups.

The physiological and subjective effects of being touched on the wrist by another person were investigated in 20 normal adults at rest and during immersion of the hand in ice water. Touching reliably reduced heart rate compared to an immediately preceding baseline and compared to an alpha biofeedback condition. Heart rate during painful ice water stimulation was also lower when the subject was touched as compared to when he/she practiced alpha biofeedback, but this effect was not mediated by a reduction in the perceived painfulness of the ice water. Instead, touching and pain had independent, additive effects on heart rate. Touching did not produce generalized reductions in respiratory rate, SRR frequency, or frontalis EMG activity, although subjects did rate being touched as more pleasant and more relaxing than practicing alpha.

The present study investigated the use of a compliance-training procedure and its effect on untreated deviant child behaviors. Three children, each generally noncompliant to adult requests and with several additional problems, such as crying, aggression, and self-injurious behavior, were trained in the compliance procedure under a multiple-baseline design across therapists. Compliance was defined as the correct response to prespecified requests. Other classes of deviant child behavior were measured continuously throughout the study but not directly reinforced. The results of the study showed that (a) increases in compliance to requests were directly related to the contingencies employed; (b) decreases in untreated deviant behaviors occurred when compliance increased, even though no direct contingencies had been placed on these behaviors; and (c) the relationship between untreated deviant behaviors and compliance appeared to be maintained by a different set of events in each of the three children. The results are discussed in terms of behavioral covariation and generalization.

The literature on age differences in life satisfaction, self-concept, and locus of control reveals a variety of conflicting findings. Nehrke et al. reported a study of elderly institutionalized males that attempted to control for some of the possible sources of variability [1]. The present study extended this effort to a noninstitutionalized life-span sample of males and females in six age groups (fourteen to ninety-four). The age main effect was significant for the locus of control measure. For self-concept, the age and sex main effects were significant. For life satisfaction, the age and sex main effects and their interaction were significant. Generally, lower levels of self-concept and life satisfaction and a more external orientation characterized adolescents and young adults while, with notable exceptions, the remaining age samples were more positive in self-concept and life satisfaction and were more internally controlled. Although the three dependent measures were significantly correlated for the total sample, the correlations involving locus of control were only moderate. The data suggest that at least the life satisfaction and self-concept measures may be viable tools to assess the psychological quality of one's life, and that reliable age differences in well-being can be demonstrated if moderating variables are controlled experimentally or statistically.

Reliable changes in a variety of behaviors, or classes of behaviors, when only one is manipulated experimentally, have demonstrated that even topographically dissimilar responses can be functionally related. We investigated such a relationship between topographically different child behaviors (compliance and inappropriate activities) by using a methodology that tests for response covariation. Five conditions were provided to sequentially increase and decrease first one and then the other of these behaviors, with the degree of covariation between the two behaviors (i.e., the relationship between changes in the targeted and nontargeted behaviors) being the finding of interest. Results showed that, regardless of the intervention used, the behavior targeted, or the direction manipulated, the nontargeted behavior reliably covaried inversely with the targeted one. The findings have immediate relevance to the clinical treatment of multiple behavior problems exhibited by children. Furthermore, the study of relationships between responses and the processes underlying these relationships can have important implications for understanding the complexity characteristic of human behavior not yet analyzed by behavioral research.

Group care settings for dependent people must be organized to facilitate delivery of responsive care and to prevent inadvertant neglect or deliberate abuse. Accordingly, in an infant and a toddler day-care center, an open environment was examined as a means to increase the visibility of children to staff and of staff-child interactions to the supervisor, and to investigate potential adverse effects of the open environment on infants' and toddlers' activities. These studies demonstrated that: (1) an open environment markedly decreased the amount of time a child could not be seen by any adult and the amount of time staff members' activities were not visible to the supervisor, and markedly reduced the effort required to supervise those who were not immediately visible; (2) an open environment did not adversely affect the sleep of either infants or toddlers; and (3) an open environment is as conducive to small group pre-academic activities with toddlers as is a separate room. These studies convinced us that infant and toddler day care can and should be accomplished in an open environment.

Background Neuroimaging technology has afforded advances in our understanding of normal and pathological brain function and development in children and adolescents. However, noncompliance involving the inability to remain in the magnetic resonance imaging (MRI) scanner to complete tasks is one common and significant problem. Task noncompliance is an especially significant problem in pediatric functional magnetic resonance imaging (fMRI) research because increases in noncompliance produces a greater risk that a study sample will not be representative of the study population. Method In this preliminary investigation, we describe the development and application of an approach for increasing the number of fMRI tasks children complete during neuroimaging. Twenty-eight healthy children ages 9-13 years participated. Generalization of the approach was examined in additional fMRI and event-related potential investigations with children at risk for depression, children with anxiety and children with depression (N = 120). Essential features of the approach include a preference assessment for identifying multiple individualized rewards, increasing reinforcement rates during imaging by pairing tasks with chosen rewards and presenting a visual 'road map' listing tasks, rewards and current progress. Results Our results showing a higher percentage of fMRI task completion by healthy children provides proof of concept data for the recommended tactics. Additional support was provided by results showing our approach generalized to several additional fMRI and event-related potential investigations and clinical populations. Discussion We proposed that some forms of task noncompliance may emerge from less than optimal reward protocols. While our findings may not directly support the effectiveness of the multiple reward compliance protocol, increased attention to how rewards are selected and delivered may aid cooperation with completing fMRI tasks Conclusion The proposed approach contributes to the pediatric neuroimaging literature by providing a useful way to conceptualize and measure task noncompliance and by providing simple cost effective tactics for improving the effectiveness of common reward-based protocols.