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The purpose of this study was to contribute to the small but growing literature on the rehabilitation of language for older adults, as well as evaluate the clinical utility of a functional approach to language assessment. The study included an assessment-based response profile that informed individualized treatment targets and prompt selection, and a multiple-baseline design across behaviors with an embedded multielement design was used to systematically compare two transfer of stimulus control procedures. Results suggested that the prompt-delay procedure resulted in positive treatment outcomes and provided valuable information on the implications of basing treatment goals on functional assessment.

Rational and Objectives This study aimed to assess resident, fellow, and fellowship director perceptions of the musculoskeletal (MSK) radiology fellowship application process. Materials and Methods A task group constructed three surveys with questions about current and “ideal” fellowship application and selection processes. Surveys were distributed to MSK fellowship directors, who were also asked to give separate surveys to current fellows. US and Canadian radiology residency directors were asked to distribute surveys to current R3 and R4 residents. Responses were tabulated and analyzed. Results Responses were received from 47 MSK fellowship directors, 73 MSK fellows, and 147 residents. Fellowship directors and fellows reported that most fellowship offers occur between July and September of the R3 year, although 19% of directors made offers as early as the R2 year. Of the 43 director respondents, 31 (72%) noted “pressure from other programs” as the main driving force behind their policies, but 28 (65%) felt that their timelines were “too early.” A formal match was supported by 55% of responding fellowship directors, 57% of fellows, and 61.9% of residents, citing “fairness” as a major justification. Conclusions MSK radiology fellowship selection occurs as early as the R2 year, before many residents have had substantial exposure to different subspecialties. An “arms race” has developed with programs moving their timelines earlier in response to the actions of other programs, presumably to avoid missing the best candidates. Although a majority of respondents would support a formalized match to increase fairness, there is not universal agreement that it would be the best approach.

The purpose of this article is to provide tactics for the behavior analyst to effectively evaluate the evidence base for an unfamiliar nonbehavioral intervention when expanding services. Just as behavior analysts must be aware of fad treatments in autism likely to be encountered, so, too, should practitioners become familiar with potential fad treatments in any expanded area of practice. The present article extends previous work by considering challenges surrounding contact with nonbehavioral literature in the context of an expanded consumer base. The article also considers ethical interactions with nonbehavioral professionals following appraisal of the intervention, and how adopting the strategies listed here can aid in establishing oneself as a resource. Associated barriers and solutions are presented around four tactics: (a) searching the literature, (b) recognizing and evaluating the common properties of fad treatments, (c) distinguishing quality of evidence, and (d) ascertaining behavioral mechanisms of action. Examples from gerontology will be provided to illustrate the use of the proposed tactics.

Paired-stimulus preference assessments have been used effectively with individuals with dementia to identify stimuli to increase engagement and to minimize negative affect and problem behavior. We evaluated whether a multiple-stimulus without replacement preference assessment could be used with older adults with dementia and whether preferences remained stable over time. Seven participants completed preference assessments and confirmatory engagement analyses every few weeks for 3 to 5 months; 1 participant failed to complete any preference assessments. Five of the 7 remaining participants displayed higher levels of engagement with the highest ranked stimuli than with the lowest ranked stimuli, confirming the hierarchy in the preference assessment. For the other 2 participants, lowest ranked items resulted in higher levels of engagement than the highest ranked items. Four participants exhibited stable patterns of preference over 3 to 5 months with correlation coefficients exceeding r = .5, suggesting that preferences may remain stable for some individuals with dementia.

A functional analysis examined the relation between consequences that maintained episodic problem behavior (aggression, property destruction, and elopement) in the presence and absence of manic behaviors (MB). Results suggested that the presence of MB was correlated with the sensitivity of problem behavior to attention as a reinforcer during a functional analysis and that problem behaviors were maintained by attention. Noncontingent reinforcement was subsequently implemented and demonstrated to be effective in reducing problem behavior during the presence of manic behaviors.

Performing oral care procedures with children with autism who exhibit noncompliance can be challenging for oral care professionals. Previous research has elucidated a number of effective behavior analytic procedures for increasing compliance, but some procedures are likely to be too time consuming and expensive for community-based oral care providers to adopt. The purpose of this study was to use Behavioral Skills Training to teach dental hygiene students and staff to implement basic function-based behavior analytic strategies to reduce noncompliance and increase their success in performing oral care exams and cleanings in vivo . All participants rapidly acquired the techniques and used them effectively during exams and cleanings following BST, and skills generalized to their completion of an X-ray procedure with several children with autism. The number of steps attempted in all procedures increased relative to baseline for all participants.

A growing workforce of behavior analysts provides services to individuals with autism and intellectual disabilities as legislative initiatives have spurred a growth of funding options to support these services. Though many opportunities currently exist for serving individuals with autism, the growing demand for these services may wane or, at some point, the growth in service providers will meet that demand. Other consumer groups could benefit from behavior analytic services, but typically have limited access to qualified providers. Individuals with dementia and traumatic brain injury are used as example consumer groups to illustrate the necessary tasks for a behavior analyst to expand their scope of practice to a new population. This paper provides strategies for developing competence and creating employment opportunities with new consumer groups.

Skinner's 1957 analysis of verbal behavior has demonstrated a fair amount of utility to teach language to children with autism and other various disorders. However, the learning of language can be forgotten, as is the case for many elderly suffering from dementia or other degenerative diseases. It appears possible that Skinner's operants may facilitate not only acquisition of language but also the ability to recall items or objects that may have appeared to be "forgotten." The present study examined the utility of having a series of adults in long-term care emit tacts, echoics, or intraverbals upon presentation of various visual stimuli. Compared to a no-verbal response condition, it appears that the incorporation of Skinner's verbal operants can in fact improve recall for this population. Implications for the retraining of lost language are presented.

The authors used a reinforcer assessment to evaluate possible interventions for hoarding in an older individual with dementia. The most preferred condition from the assessment (sorting activity) was compared to a staff developed treatment involving item removal and redirection. Hoarding was reduced during both interventions with a greater reduction in the sorting condition. The behavioral reductions were maintained during schedule thinning of social interactions and follow-up.

The current study compared an abbreviated oral interview version of the Pleasant Events Schedule – Alzheimer’s Disease (PES-AD) to a multimedia-supplemented version. Both measures identified multiple preferred items and their scores were moderately correlated (r ¼ .481). Direct observations were conducted to determine whether either of the two measures predicted subsequent engagement. For all nine individuals with dementia, items endorsed as preferred by both versions of the PES-AD resulted in high levels of engagement and items endorsed as non-preferred items on both measures resulted in low to moderate levels of engagement. Individuals with MMSE scores of 10 or higher had more stable and differentiated patterns of engagement than individuals with scores below 10. For individuals with higher MMSE scores, items endorsed only by the multimedia version resulted in high engagement levels (i.e., true positive) while items endorsed only on the verbal presentation resulted in low levels (i.e., false positive). Copyright # 2008 John Wiley & Sons, Ltd.

Aphasia is an acquired language impairment that affects over 1 million individuals, the majority of whom are over age 65 (Groher, 1989). This disorder has typically been conceptualized within a cognitive neuroscience framework, but a behavioral interpretation of aphasia is also possible. Skinner's (1957) analysis of verbal behavior proposes a framework of verbal operants that can be integrated with the work of Sidman (1971) and Haughton (1980) to describe the language difficulties individuals with aphasia experience. Using this synthesis of models, we propose a new taxonomy of aphasia based on the observed deficit relations. Assessment and treatment implications are also discussed.

Behavior analysts have long recognized the importance of experimental research with and providing behavioral supports to older adults. While previous reviews have covered published literature associated with experimental and applied demonstrations of behavioral principles with older adults, relatively few have focused on how that published literature could guide research and clinical considerations for behavior analysts working with older adults. This chapter will focus on how behavior analysts might expand their research or clinical interests into aging settings.

Fifty-six active treatment team members in long-term nursing care facilities completed an online survey assessing treatment acceptability of modern behavioral, pharmacological, and sensory interventions. A traditional treatment acceptability rating scale was compared to treatment selections in a paired-options format. Unlike earlier research, there were no significant differences in acceptability between the 3 interventions on the traditional rating scale. However, ratings and selections were significantly correlated for behavioral and pharmacological interventions. The clinical significance of such relations and the implications for the use of treatment ratings is discussed.

In the current study, nursing home staff were taught to administer functional analyses to determine the variables maintaining aggression by an elder with dementia. The results indicated that aggression was evoked during bathroom routines and that escape maintained aggression. Staff then reduced aggression to near-zero levels with noncontingent escape. Implications for the assessment and treatment of problem behaviors in nursing home settings are discussed.

Wandering is a difficult-to-manage behavior problem for individuals with cognitive impairments that can jeopardize safety if an individual enters a hazardous area or becomes lost. This study investigated the effects of a cloth barrier on entry into an unsafe area. The cloth barrier reduced entry into the restricted area and had high treatment acceptability.