Maternal acceptability of a dietary intervention designed to lower children's intake of saturated fat and cholesterol: the Dietary Intervention Study in Children (DISC).

OBJECTIVE: This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC). DESIGN: DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group. SUBJECTS/SETTING: To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8-to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States. INTERVENTION: Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat. MAIN OUTCOME MEASURES: Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study. STATISTICAL ANALYSIS PERFORMED: Statistical procedures included factor analysis and regression analysis. RESULTS: Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers' having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake. APPLICATIONS/CONCLUSIONS: In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children.

Enhancing child compliance with nebulized respiratory treatment. A case study.

A 2.7-year-old developmentally delayed boy diagnosed as having chronic lung disease, severe hyaline membrane disease, and persistent pulmonary hypertension with interstitial emphysema was referred in hopes of modifying his refusal to wear a mask during nebulized administrations of Chromolyn. The child was prescribed four 20-minute nebulized treatments daily but resisted treatment and removed the mask by turning his head and pushing the mask away with his hands. A procedure was implemented to gradually teach the child that turning his head and pushing the mask would not result in mask removal, and that by wearing the mask he would receive positive attention. By the end of treatment, the child was consistently wearing his mask for the required 20-minute intervals. Follow-up at 3 months confirmed maintenance of treatment effects.

A biobehavioral approach toward managing encopresis.

The purpose of this study was to evaluate the effectiveness of a biobehavioral treatment approach for two encopretic children. Both subjects were evaluated and treated by a pediatric gastroenterologist, with behavioral interventions occurring subsequent to, and in conjunction with, the medical intervention. Results showed that the biobehavioral approach resulted in significant improvements for both subjects, and that the use of response cost may be a necessary intervention component for some children. A model is also presented to clarify the relationship between organic and nonorganic factors and their relationship to encopresis.

Teaching self-administration of nasogastric tube insertion to an adolescent with Crohn disease.

We examined the effectiveness of simulation training to teach an adolescent male with Crohn disease to self-administer nasogastric tube insertion. Nasogastric tube insertion was taught using simulation training, after which self-insertion skills were assessed. Results across skill components indicated that this subject was able to self-administer insertion of the nasogastric tube.

Using parents as therapists to evaluate appropriate behavior of their children: application to a tertiary diagnostic clinic.

We conducted a preliminary analysis of maintaining variables for children with conduct disorders in an outpatient clinic. Eight children of normal intelligence between the ages of 4 and 9 years were evaluated during 90-min sessions. The children's parents conducted the assessments by varying task demands (easy and difficult) and parental attention (attention and no attention) within a multielement design. The assessment focused on appropriate child behavior and was conducted to formulate hypotheses regarding maintaining contingencies. Results demonstrated that the children's appropriate behavior varied across assessment conditions and, for 7 of the 8 children, occurred at a higher rate during one condition than during other conditions. In addition, treatment integrity data demonstrated that parents were able to implement the procedures as intended. The recommended treatments were rated as being both effective and acceptable to parents for up to 6 months following the evaluation. Our results extend previous studies of functional analytic procedures conducted by trained experimenters with severely handicapped children in more controlled settings.

Use of descriptive and experimental analyses to identify the functional properties of aberrant behavior in school settings.

We conducted descriptive and experimental analyses of aberrant behavior in school settings with 2 children with autism, using teachers as assessors. Experimental functional analyses carried out by the investigators were followed by training teachers to conduct a descriptive analysis and a classroom experimental analysis. A comparison of the assessment procedures showed that each procedure identified negative reinforcement as a maintaining variable for aberrant behavior. The teacher implemented an intervention based on the assessment with mixed results. We then replicated the initial results by having the first teacher train a second teacher to carry out the two assessment procedures. The results of these analyses were also in agreement, again identifying negative reinforcement as a variable maintaining aberrant behavior. An intervention based on negative reinforcement was then successfully implemented. These results suggest the applicability and utility of functional analyses carried out in school settings.

Use of negative reinforcement in the treatment of self-injurious behavior.

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a pre-recorded message of "stop"). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.

Parental acceptability of treatments for children's hypercholesterolemia.

This study examined the acceptability ratings of three alternative treatments applied to case descriptions which varied in their level of problem severity. Evaluations were provided by 40 parents seeking services in a Pediatric Preventive Cardiology Clinic for treatment of their children's hypercholesterolemia. Results indicated that both diet and diet plus goal setting were rated as significantly more acceptable than medication. Ratings of diet and diet plus goal setting did not vary as a function of problem severity, however, medication was rated as more acceptable when applied to a more severe case example, as opposed to a mild case example. Findings are discussed in relation to the clinical significance of these findings and the need for future research.

Risk factors for adolescent cigarette smoking. The Muscatine study.

Smoking among adolescents is a developmental phenomenon with several factors exerting an influence on cigarette use at different times. We examined the longitudinal influences of several behavioral and social variables on the smoking status of 443 students followed from early to late adolescence. Of the factors examined, association with friends who smoke and previous smoking status were consistently associated with an adolescent's future smoking status. Other factors, such as attachment to father or to mother, parental supervision, extracurricular activity, perceived negative and positive effects of smoking, and academic involvement, were all related to late adolescent smoking status. These observations suggest that strategies that influence smoking behavior need to be directed not only to the individual child but also to influences within the child's home and school environment.