Coaching parents to assess and treat self-injurious behaviour via telehealth.

The application of telehealth technology to conduct functional analysis (FA) and functional communication training (FCT) is emerging for children with developmental disabilities and behaviour support needs. The current study was designed to extend FA + FCT for self-injurious behaviour by using telehealth in home with parents as interventionists receiving real-time remote coaching. Two families with school-aged boys with developmental disabilities associated with intellectual disability participated, one with cerebral palsy and the other with autism spectrum disorder. Results indicated that parent-implemented FA + FCT via telehealth was effective for reducing self-injurious behaviour and increasing mands (communication requests) for both children. Both families successfully implemented the FA + FCT protocol with 95% overall fidelity via telehealth-supported coaching. Results are discussed in terms of their relationship to previous research, limitations and future directions.

Experiences of student and practicing physical therapists with inappropriate patient sexual behavior.

BACKGROUND AND PURPOSE: The objectives of this study were (1) to describe the extent to which practicing physical therapists and physical therapy students have reported experiencing inappropriate patient sexual behavior (IPSB), (2) to document the consequences of IPSB, and (3) to identify the strategies the subjects have used to manage IPSB. SUBJECTS AND METHODS: A survey questionnaire was sent to 118 physical therapists and 87 physical therapy students. Completed questionnaires were returned by 74.1% of the subjects (over 70% in each group). RESULTS: The majority of respondents (80.9%) reported having encountered some level of IPSB. Although almost half of the physical therapists and one third of the third- and fourth-year students reported experiencing severe IPSB, including forceful sexual touching and deliberate sexual exposure, only 20% of the respondents perceived that they had been "sexually barassed." Most of the respondents were satisfied with the way in which they handled the IPSB; however, almost 90% considered that in-service and undergraduate education would be desirable. CONCLUSION AND DISCUSSION: It is concluded that this problem should be addressed by further study with a broader sample and by inclusion of these issues in education programs for students and physical therapists.

Children's Memory for Locations Visited: Importance of Movement and Choice.

In 2 experiments, the effect of active or passive mobility and active or passive choice experiences on children's memory for locations visited while retrieving puzzle pieces hidden in a large room were examined. In the first experiment, fifty-two 6- and 7-year-old children were randomly assigned to 1 of 4 training conditions: active choice-active movement, active choice-passive movement, passive choice-active movement, and passive choice-passive movement. After 3 training trials, all children were tested in the active choice-active movement condition. A 2 (movement) x 2 (choice) factorial multivariate analysis of variance revealed a significant main effect for movement. Children who had moved actively to find the puzzle pieces in the training trials had (a) a greater percentage correct, (b) more correct visits between errors, and (c) a later visit of first error than children who had been passively pushed in a wheelchair. Making active choices in training did not significantly affect performance. A second experiment used identical procedures but tested 32 children with mobility difficulties who regularly used a wheelchair because of either cerebral palsy or spina bifida. Children from this group who moved actively during training to retrieve the puzzle pieces also performed better on testing. Implications of the results for children with disabilities and for developmental theory are discussed.

Conditional use of a request for assistance.

PURPOSE: To establish the conditional use of requests for assistance as an alternative to escape maintained challenging behaviour. METHOD: The study involved a 12-year-old boy with a behaviour disorder. Experiment 1 involved the implementation of a reversal design comparing the learner's performance during "easy" and "difficult" addition problems. Experiment 2 involved the implementation of a quasi-experimental design to establish the conditional use of requests for assistance. RESULTS: Conditional use of requests for assistance successfully competed with escape maintained challenging behaviour. CONCLUSIONS: Our results suggest that for a newly acquired response to be displayed conditionally, two events must occur. First, the individual must learn the skill that has been associated with requests for assistance. Secondly, the contingencies must be such that reinforcement value is greater for an independent response than for a response that involves a request for assistance.

Use of a concurrent operants paradigm to evaluate positive reinforcers during treatment of food refusal.

The authors evaluated the responsiveness of 4 preschool-aged children to positive reinforcers within a concurrent operants paradigm during mealtimes. The children were presented with two identical, concurrently available sets of food. Each set differed in quantity and quality of positive reinforcement paired with acceptance of each bite of food or in the number of bites of food required to obtain positive reinforcement. Experiment 1 evaluated 1 child's responsiveness to positive reinforcement while permitting escape from bite offers. Experiment 2 evaluated 2 children's responsiveness to positive reinforcement when escape extinction occurred. Results from these experiments suggested that the children were responsive to positive reinforcers and chose more often the bites paired with the greater quantity and/or quality of reinforcement. Experiment 3 evaluated 1 child's responsiveness to positive reinforcement both without and with escape extinction. Results suggested that positive reinforcement affected choice behavior and that escape extinction affected amount of food consumed.

Acceptance of an injury-prevention program in rural communities: a preliminary study.

INTRODUCTION: Considerable attention is being addressed to injury prevention. This study addresses the acceptance of a home injury-prevention survey as an injury-prevention tool in rural communities. PURPOSE: The purpose of this study was to evaluate public acceptance of a home injury-prevention survey as a tool to educate and enlighten the public about home injuries. METHODS: All patients with home injuries who came to Wetzel County Hospital Emergency Department were asked if they would participate in a home injury-prevention survey. The study was conducted from 01 May to 01 July 1995. Paramedics were used as interviewers because of the closeness they enjoy with the community. RESULTS: During the study period, 2,104 patients came to the emergency department of Wetzel County Hospital. Of these, 386 sought care because of an injury sustained in their homes. From this group, 23 (5.9%) patients agreed to participate in a home injury-prevention study; 363 (94.1%) refused. CONCLUSION: A home injury-prevention survey alone does not seem to be an effective tool to aid in the reduction of home injuries, because it is not embraced by the general public.

Client-centered approach to develop a seating clinic satisfaction questionnaire: a qualitative study.

OBJECTIVE: The purpose of this study was to develop a program evaluation tool through a client-centered approach. Client satisfaction questionnaires previously developed for service recipients of a pediatric seating clinic have reflected the professionals' views on what should be asked. METHOD: Seven parents and caregivers of recent service recipients of the seating clinic participated in tape-recorded semistructured interviews. They were asked their views on the seating clinic, how the service could be improved, and the quality of the seat received through the clinic. RESULTS: Data were coded into nine themes related to the process and the product. Using these themes and the vocabulary used by the participants, we developed a satisfaction questionnaire. The validity of the questionnaire was evaluated by requesting feedback on clarity, content, and design from all participants and from a panel of five health professionals. CONCLUSION: A client-centered approach can be used to develop a client satisfaction tool that reflects the needs of the users. Future work will involve testing the tool in the clinical setting.

The effects of form training on foul-shooting performance in members of a women's college basketball team.

The effects of instruction and feedback in proper form on foul-shooting performance was evaluated in 3 players of a women's NCAA Division II college basketball team. Players showed an increase in percentage of shots made and in correct form compared to baseline shooting without instruction or feedback. All players reached criterion within seven training sessions. The results suggest that training proper form is an effective strategy for improving foul-shooting performance.

Increasing accuracy and decreasing latency during clean intermittent self-catheterization procedures with young children.

We examined the effects of simulation training on performance of clean intermittent self-catheterization procedures with 2 young girls. Simulation training was conducted, after which independent performance was assessed within a multiple baseline design. The training resulted in increased accuracy and decreased latency for both girls.

Designing interventions that include delayed reinforcement: implications of recent laboratory research.

UNLABELLED: The search for robust and durable interventions in everyday situations typically involves the use of delayed reinforcers, sometimes delivered well after a target behavior occurs. Integrating the findings from laboratory research on delayed reinforcement can contribute to the design and analysis of those applied interventions. As illustrations, we examine articles from the Journal of the Experimental Analysis of Behavior that analyzed delayed reinforcement with respect to response allocation (A. M. Williams & Lattal, 1999), stimulus chaining (B. A. Williams, 1999), and self-control (Jackson & Hackenberg, 1996). These studies help to clarify the conditions under which delayed reinforcement (a) exercises control of behavior, (b) entails conditioned reinforcement, and (c) displaces the effects of immediate reinforcement. The research has applied implications, including the development of positive social behavior and teaching people to make adaptive choices. DESCRIPTORS: delayed reinforcement, response allocation, stimulus chains, self-control, integration of basic and applied research

Escape behavior during academic tasks: a preliminary analysis of idiosyncratic establishing operations.

The presence or absence of idiosyncratic stimuli has been demonstrated to predictably alter the occurrence of problem behavior. By specifying stimuli related to negatively reinforced behavior during academic tasks, it may be possible to identify methods of instruction that decrease the occurrence of problem behavior. The current study used a four-step procedure that involved a functional analysis, descriptive assessment, establishing operations (EO) analysis, and follow-up evaluation (a) to identify the operant function of destructive behavior and (b) to evaluate the effects of idiosyncratic features of academic task demands and related methods of instruction on the occurrence of negatively reinforced destructive behavior of 3 boys with developmental disabilities and autism in a classroom setting. The data suggest that the four-step procedure was effective in identifying methods of instruction that decreased the likelihood of destructive behavior without disrupting the maintaining contingencies for destructive behavior. Results are discussed in terms of establishing operations for negatively reinforced destructive behavior during academic tasks and related methods of instruction in classroom settings.

Increasing compliance with medical procedures: application of the high-probability request procedure to a toddler.

The effects of high-probability (high-p) requests on compliance with low-probability (low-p) responses have received increased attention from applied investigators. This study examined the effects of a high-p procedure on a toddler's compliance with medical procedures. Compliance to low-p requests occurred more frequently following compliance to high-p requests, suggesting that this procedure may be useful across different topographies of compliance.

The effects of presession exposure to attention on the results of assessments of attention as a reinforcer.

The effects of presession exposure to attention on responding during subsequent assessments of attention as a reinforcer were evaluated across three behavioral assessments. In Experiment 1, a contingent attention assessment condition was preceded by either a noncontingent attention condition (free play) or a contingent escape condition. In Experiment 2, a diverted attention with extinction condition was preceded by either an alone or a free-play condition. In Experiment 3, a two-choice preference assessment was preceded by either 10 min of free play or 10 min of playing alone. In each experiment, the participant responded differentially within the test condition according to the presence or absence of dense schedules of attention immediately prior to that condition. The results of this study show that events occurring immediately prior to an assessment condition can influence behavior within the assessment.

Separate and combined effects of methylphenidate and a behavioral intervention on disruptive behavior in children with mental retardation.

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.

Brief experimental analysis of stimulus prompts for accurate responding on academic tasks in an outpatient clinic.

Brief multielement designs were used to examine the effects of specific instructional strategies on accuracy of academic performance during outpatient evaluations of 4 children with learning disorders. Instructional strategies that improved accuracy on academic tasks were identified for all participants. These results suggest that the application of experimental analysis methodologies to instructional variables may facilitate the identification of stimulus prompts that are associated with enhanced academic performance.

Use of component analyses to identify active variables in treatment packages for children with feeding disorders.

We evaluated the separate components in treatment packages for food refusal of 4 young children. First, treatment packages were implemented until food acceptance improved. Next, a component analysis was conducted within a multielement or reversal design to identify the active components that facilitated food acceptance. The results indicated that escape extinction was always identified as an active variable when assessed; however, other variables, including positive reinforcement and noncontingent play, were also identified as active variables for 2 of the children. The results suggest that the component analysis was useful for identifying variables that affected food acceptance.

Choice-making treatment of young children's severe behavior problems.

The choice-making behavior of 5 young children with developmental disabilities who engaged in aberrant behavior was studied within a concurrent operants framework. Experimental analyses were conducted to identify reinforcers that maintained aberrant behavior, and functional communication training packages were implemented to teach the participants to gain reinforcement using mands. Next, a choice-making analysis, in which the participants chose one of two responses (either a mand or an alternative neutral response) to obtain different durations and qualities of reinforcement, was conducted. Finally, treatment packages involving choice making via manding were implemented to decrease inappropriate behavior and to increase mands. The results extended previous applications of choice making to severe behavior disorders and across behaviors maintained by positive and negative reinforcement.

A brief component analysis of potential treatment packages in an outpatient clinic setting with young children.

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.

Current uses of virtual reality for children with disabilities.

Technological advances, including the use of virtual reality, have contributed enormously to improving the treatment, training, and quality of life of children with disabilities. This paper describes the advantages of VR for children with disabilities, how VR can minimize the effects of a disability, the role of VR in training and skills enhancement, and how social participation and the child's quality of life may be improved through the use of VR. Examples from published literature and Internet sites are given of current and completed projects which focus on improving the lives of children with disabilities. The research describing the efficacy of knowledge and skills transfer from a virtual environment to the real world are examined in relation to children with disabilities. Finally, the current limitations and future directions of VR for children with disabilities are considered.