The Munroe-Meyer Approach: Continuous Integration of Didactic Instruction, Research, and Clinical Practice.

Increased demand for applied behavior analysis (ABA) services has increased the need for additional masters-level practitioners and doctoral-level academicians and clinical directors. Based on these needs, the University of Nebraska Medical Center's (UNMC) Munroe-Meyer Institute has developed a PhD program. The academic structure at UNMC allowed us to create our PhD program in a relatively quick and efficient manner. Our PhD program has many unique features, including (a) close integration of didactic instruction with clinical and research training provided by leading experts in ABA in which students immediately apply concepts introduced in the classroom during coordinated clinical and research practica; (b) structured grant writing training in which students learn to write and submit an NIH-level grant;

External hand warming as a novel treatment for ice pick headaches: a controlled case study.

Primary stabbing headache (PSH) or ice pick headache is an infrequently studied, yet socially important problem facing children and adolescents. The current study examined the effects of routine external hand warming on the PSH intensity of a 16-year-old male referred for management of recurrent headaches. The participant, Michael, alternated periods of non-warming with periods of daily external hand warming, and an ABAB design was used to evaluate the impact of hand warming on PSH intensity. Results indicate that clinically significant symptom reduction was obtained with implementation of external hand warming.

Evaluation of the effects of the VibraJect attachment on pain in children receiving local anesthesia.

PURPOSE: The purpose of this study was to evaluate the effectiveness of VibraJect, a vibrating attachment for a traditional syringe, in reducing pain related disruptive behavior and self-reported pain in children receiving local anesthesia. METHODS: The procedure involved a randomized, controlled, single-blinded study of 90 children receiving local anesthesia for routine restorative procedures. Participants were randomly assigned to either a control (injection as usual) or experimental (injection using the VibraJect) group. Participants were recruited from a large, urban pediatric dental clinic within a university medical center. RESULTS: Using 2-way analysis of variance and 2-tailed, between-subject t tests, there were no significant differences between injection with and without the VibraJect on any measures of pain, including self-reported intensity, independent direct observations of pain related disruptive behavior, and subjective dentist ratings. CONCLUSIONS: VibraJect did not provide any benefits over a conventional approach to anesthesia injection for children in this study.

Stimulus Preference Assessment Decision-Making System (SPADS): A Decision-Making Model for Practitioners.

A stimulus preference assessment (SPA) is a fundamental tool used by practitioners to predict stimuli that function as reinforcers. The Behavior Analyst Certification Board (BACB) requires that all certified behavior analysts and behavioral technicians be trained in SPA methodology (BACB, 2017). SPA procedures are used by nearly 9 out of 10 behavior analysts in the field (Graff & Karsten, 2012). Over the last 4 decades, there has been a litany of research on SPA procedures. Despite the universality of training, application, and research, discussions on the selection of SPA procedures have been sparse. Two peer-reviewed articles have focused on clinical decision making in the selection of SPA procedures. Karsten et al. (2011) introduced an in situ decision-making model, whereas Virues-Ortega et al. (2014) developed an a priori algorithm based on client and stimuli characteristics. The SPADS addresses the limitations of prior models by considering the effects of stimuli dimensions, client characteristics, relative administration times, and the outcomes agreement between two potentially efficacious, context-specfic SPA procedures.

Pediatric Prevention: Oral Health Care.

Children who have a dental home are more likely to receive preventative care, require fewer dental treatments, and are less likely to have dental disease. Many children demonstrate behavior management concerns that may impede families from establishing a dental home for their children. Conceptually, behavior concerns develop through a process of conditioning. Prevention of such problems should focus on providing positive experiences related to dental care. Treatment components to address behavior management concerns include graduated exposure, contingent reinforcement, modeling and prompting, distraction/relaxation, and cognitive behavior therapy. Further support, training, and reimbursement for time required to administer such treatment is needed.

Genomic characterization of the complete terpene synthase gene family from Cannabis sativa.

Terpenes are responsible for most or all of the odor and flavor properties of Cannabis sativa, and may also impact effects users experience either directly or indirectly. We report the diversity of terpene profiles across samples bound for the Washington dispensary market. The remarkable degree of variation in terpene profiles ultimately results from action of a family of terpene synthase genes, only some of which have been described. Using a recently available genome assembly we describe 55 terpene synthases with genomic context, and tissue specific expression. The family is quite diverse from a protein similarity perspective, and subsets of the family are expressed in all tissues in the plant, including a set of root specific monoterpene synthases that could well have agronomic importance. Ultimately understanding and breeding for specific terpene profiles will require a good understanding of the gene family that underlies it. We intend for this work to serve as a foundation for that.

Decreasing disruptive behaviour during routine dental visits: a video modelling intervention for young children.

OBJECTIVE: To evaluate the benefits of a collaborative partnership between paediatric dentists and behavioural health providers in which a practical video modelling intervention, with the aim to reduce disruptive behaviours in young children, is implemented. METHODS: The video was created by a dentist using readily available technology and implemented in a busy practice setting. A clinical sample of 40 children, 3-6 years old, was recruited from a continuous sample of patients seen at the clinic. Participants were randomised into two groups and shown either the brief video model or a control video prior to a routine dental visit. All sessions were videotaped and independently scored by blinded observers. Behavioural data were recorded using 15-second partial-interval recording and included physical and vocal disruptions. Subjective measures of cooperation were also completed by observers and dental professionals. RESULTS: Independent samples t-tests show that the treatment group had a significantly lower mean percentage of intervals in which disruptive behaviour was observed [t(38) = 2.94, P = 0.008] compared with the control group. Subjective rating scales revealed significantly higher ratings of cooperation for the treatment group from the dentist [t(38) = -5.19, P = 0.000], the dental assistant [t(38) = -4.01, P = 0.001] and the blinded coder [t(38) = -3.54, P = 0.002]. Significant relationships were found between the percentage of actual disruptive behaviour and subjective ratings of the dentist (r = -0.82, P < 0.01). CONCLUSIONS: Watching a brief dentist-created video model of expected procedures can reduce disruptive behaviour and increase cooperation for young children making their first visit to a busy medical setting.

An experimental demonstration of AAB renewal in children with autism spectrum disorder.

Operant renewal is a return of extinguished behavior due to changes in contextual stimuli that control the occurrence or nonoccurrence of a response. Well-established in classical conditioning and operant research, renewal presents itself in three forms-ABA, ABC, and AAB-and poses threats to treatment maintenance where extinction procedures are utilized. As AAB renewal may be less likely to occur than ABA or ABC renewal, the current study sought to determine if AAB renewal would occur with three participants with Autism Spectrum Disorder who were taught a simple lever pull response. Results showed that lever pulls increased for two of three participants when we introduced novel stimuli (i.e., a light and a buzzer) to alter the contextual environment after extinction. These findings suggest that AAB renewal may account for some instances of response recovery after extinction and that the procedure of this study may be beneficial to the further study of renewal and the variables that affect its occurrence within a translational model.

An evaluation of the production effects of video self-modeling.

A multiple baseline across tasks design was used to evaluate the production effects of video self-modeling on three activities of daily living tasks of an adult male with Autism Spectrum Disorder and Intellectual Disability. Results indicated large increases in task accuracy after the production of a self-modeling video for each task, but before the video was viewed by the participant. Results also indicated small increases when the participant was directed to view the same video self-models before being prompted to complete each task.

The efficacy of noncontingent escape for decreasing children's disruptive behavior during restorative dental treatment.

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff s use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior.

Evaluation of increasing antecedent specificity in goal statements on adherence to positive behavior-management strategies.

We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the use of behavior-specific praise by 4 participants was found to be unaffected by goal statements that increasingly specified the behavior to be used and the conditions under which the behavior should occur. However, adherence by 3 of the 4 participants did change when goal statements included teacher-specified frequencies with which the behavior should occur. Results were systematically replicated in a second study in which, in a concurrent multiple baseline design, 3 participants showed marked increases in adherence when goal statements specified the target behavior, the conditions under which it should occur, and the frequency with which it should occur.

Biofeedback treatment of paradoxical vocal fold motion and respiratory distress in an adolescent girl.

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the criterion. Overall, baseline muscle tension levels were reduced over 60%, with corresponding reductions in episodes of respiratory distress and chest pain. Subjective reports by the patient and the patient's mother indicated improvements in school attendance and overall adaptive functioning.

An evaluation of parent-produced video self-modeling to improve independence in an adolescent with intellectual developmental disorder and an autism spectrum disorder: a controlled case study.

We evaluated a parent-created video self-modeling (VSM) intervention to improve independence in an adolescent diagnosed with Intellectual Developmental Disorder (IDD) and Autism Spectrum Disorder (ASD). In a multiple baseline design across routines, a parent and her 17-year-old daughter created self-modeling videos of three targeted routines needed for independence in the community. The parent used a tablet device with a mobile app called "VideoTote" to produce videos of the daughter performing the targeted routines. The mobile app includes a 30-s tutorial about making modeling videos. The parent and daughter produced and watched a VSM scene prior to performing each of the three routines in an analogue community setting. The adolescent showed marked, immediate, and sustained improvements in performing each routine following the production and implementation of the VSM. Performance was found to generalize to the natural community setting. Results suggest that parents can use available technology to promote community independence for transition age individuals.

Behavioral Health Screening in Pediatric Primary Care: A Pilot Study.

This pilot study investigated the effect of the Pediatric Symptom Checklist (PSC) on identification of and physician response to behavioral health (BH) concerns. Researchers reviewed 1211 charts of youth aged 4 to 16 years. Records were compared during baseline and an intervention consisting of implementation of the PSC to determine the rate of BH identification and pediatrician response. Access to PSC data resulted in a trivial difference in BH concerns identified by physicians and did not affect physician responses. This case study demonstrates that simply implementing BH screening in primary care may not result in improved outcomes for these children.

Formation of a Novel Macrocyclic Alkaloid from the Unnatural Farnesyl Diphosphate Analogue Anilinogeranyl Diphosphate by 5-Epi-Aristolochene Synthase.

As part of an effort to identify substrate analogs suitable for helping to resolve structural features important for terpene synthases, the inhibition of 5-epi-aristolochene biosynthesis from farnesyl diphosphate (FPP) by the tobacco 5-epi-aristolochene synthase incubated with anilinogeranyl diphosphate (AGPP) was examined. The apparent noncompetitive nature of the inhibition supported further assessment of how AGPP might be bound to crystallographic forms of the enzyme. Surprisingly, the bound form of the inhibitor appeared to have undergone a cyclization event consistent with the native mechanism associated with FPP catalysis. Biocatalytic formation of a novel 13-membered macrocyclic paracyclophane alkaloid was confirmed by high-resolution GC-MS and NMR analysis. This work provides insights into new biosynthetic means for generating novel, functionally diversified, medium-sized terpene alkaloids.

Comparison of a computerized anesthesia device with a traditional syringe in preschool children.

PURPOSE: The purpose of this investigation was to evaluate the efficacy of a computerized injection device (Wand) on reducing pain behavior during injections with preschool-aged children. METHODS: Subjects consisted of 40 patients between the ages of 2 and 5 requiring local anesthesia for dental restorations in the maxilla. Patients were randomly assigned to either the Wand or the traditional anesthetic delivery system. A palatal approach to the anterior and middle superior alveolar nerves and the anterior superior alveolar nerve was used with the Wand injections. Buccal infiltration and palatal injections were used for the traditional method. Pain behavior was observed and coded. RESULTS: Results of Fisher Exact tests found that using the Wand to deliver anesthetic lead to significantly fewer (P < .01) disruptive behaviors in preschool-aged children when compared with a traditional injection regimen. In addition, none of the preschool-aged children exposed to the Wand required restraint during the initial interval, while nearly half of the children receiving a traditional injection required some type of immediate restraint. CONCLUSIONS: These results demonstrate that the Wand can significantly reduce disruptive behaviors in a population of young children who are traditionally more difficult to manage and may be one method of creating a more positive experience for the young child and the practitioner.

Evaluation of two predictors of child disruptive behavior during restorative dental treatment.

PURPOSE: The purpose of this study was to evaluate the effectiveness of 2 behavior rating scales (1 describing child behavior and the other describing parent behavior) in predicting child behavior during dental treatment. METHODS: Participants consisted of 52 children, ages 3 to 12 years, and their parents. Parents completed the Eyberg Child Behavior Inventory and the Parent-Child Relationship Inventory while children received restorative dental treatment. Disruptive behavior was observed and coded. Dentists also provided subjective Frankl ratings of child behavior. RESULTS: Correlational analyses confirmed that age was the single best and only independent predictor of disruptive behavior in children during a restorative dental visit. However, a backward multiple regression demonstrated that the Support Scale and Limit Setting Scale of the Parent-Child Relationship Inventory were significant predictors of child disruptive behavior, but only when both scales were in the regression analysis. The Frankl ratings also significantly predicted observed disruptive behavior, supporting the construct validity of both the objective and subjective measures of problem behavior. CONCLUSIONS: Child age and parent reports of the parent-child relationship predicted child disruptiveness in the dental clinic, while parent reports of child behavior alone did not.

Effectiveness of using noncontingent escape for general behavior management in a pediatric dental clinic.

In a randomized controlled trial, 151 children 2 to 9 years old were exposed to either usual behavior management or to a fixed-time schedule of brief breaks (noncontingent escape) from ongoing dental treatment. Results demonstrated that the routine delivery of scheduled breaks from treatment significantly reduced the vocal and physical disruptive behavior and the need for restraint in a nonclinical sample of children undergoing restorative dental treatment. In addition, the treatment did not add significantly to the typical time spent on behavior management by dentists. Together with findings from previous studies, these results suggest that using brief breaks from ongoing dental treatment has good efficacy, acceptability, and generality and may be a useful management tool, both in everyday dental practice and in more demanding instances of specialized need.

An evaluation of the observer effect on treatment integrity in a day treatment center for children.

Treatment integrity is an important concern in treatment centers but is often overlooked. Performance feedback is a well-established approach to improving treatment integrity, but is underused and undervalued. One way to increase its value to treatment centers may be to expose unrealized benefits on the observer who collects the performance feedback data. This "observer effect" could increase the value of performance feedback and promote more consistent evaluation of treatment integrity. The purpose of this investigation was to evaluate the observer effect on treatment integrity. Five supervisors who worked in a day treatment center were asked to collect performance feedback data on staff members' integrity in following a standard treatment protocol that supervisors were also expected to follow. Results showed an immediate and marked improvement in treatment integrity in three supervisors who collected but never received performance feedback. For two supervisors, this effect was reversed and replicated. Implications are discussed.

Evaluation of a behavioral treatment package to reduce sleep problems in children with Angelman Syndrome.

The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11 years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide independent evaluations of sleep-wake activity. The treatment package targeted the sleep environment, the sleep-wake schedule, and parent-child interactions during sleep times. Treatment was introduced sequentially, across families, and evaluated in an interrupted time series, multiple baseline design. Data show that prior to treatment, baseline rates of nighttime disruptive behavior were stable or increasing and none of the participants were falling to sleep independently. With the introduction of treatment, all participants quickly learned to initiate sleep independently. Gradual reductions were reported in disruptive behaviors and these improvements were sustained over time. Results were replicated with two participants when treatment was withdrawn and reinstated. Changes in disruptive bedtime behaviors and in sleep onset were found to be statistically significant. Parents indicated high satisfaction with the treatment. A behavioral treatment package was found to be effective with five children with long histories of significant sleep-related behavior problems. These results suggest that behavioral treatment may be a reasonable way to address sleep problems in some children with Angelman Syndrome.