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 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;

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.

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.

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.

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.

Use of video eyewear to manage distress in children during restorative dental treatment.

PURPOSE: The purpose of this study was to evaluate the effectiveness of video eyewear in reducing disruptive behavior in a typical pediatric dental population during restorative treatment appointments. METHODS: One hundred twenty-eight 4- to 16-year-olds were recruited from a continuous sample of patients seen in an urban dental clinic. Direct observations of distress, self-reported measures of pain, and patient satisfaction were obtained in a randomized clinical trial comparing 2 different types of glasses: (1) wraparound video eyewear; and (2) sunglasses (typical treatment in this dental clinic). RESULTS: Analyses of covariance, using treatment condition (control vs experimental) as the primary independent variable and controlling for the effects of age, found that children wearing video eyewear glasses demonstrated significantly less disruptive behavior than those in the control group and that they liked their eyewear significantly better than those wearing the regular sunglasses. CONCLUSIONS: Wraparound video eyewear can be an effective approach to managing distress in children undergoing restorative dental treatment.

Use of audio cuing to expand employment opportunities for adolescents with autism spectrum disorders and intellectual disabilities.

We evaluated audio cuing to facilitate community employment of individuals with autism and intellectual disability. The job required promoting products in retail stores by wearing an air-inflated WalkAround® costume of a popular commercial character. Three adolescents, ages 16-18, were initially trained with video modeling. Audio cuing was then used by an attendant who delivered prompts regarding when to perform job skills. The two interventions were evaluated in an interrupted time series withdrawal design during training and then again in an actual job setting. Results show video modeling was not effective. However, the audio cuing produced job performances well above the designated criteria during training and when on the job. These changes were replicated with each participant, demonstrating clear experimental control. The changes proved statistically significant as well. Participants and parents reported high job satisfaction. The challenges of competitive employment for individuals with autism and intellectual disabilities are discussed.

Visual performance feedback: effects on targeted and nontargeted staff.

This study used a multiple baseline with reversal design to assess whether visual performance feedback (VPF) influenced targeted and nontargeted staffs' use of behavior-specific praise (BSP) in a day-treatment program. This study expands on the typical VPF audience and assesses whether VPF can be effective with noncertified staff in a day-treatment program for young children with behavior disorders, an environment in which it is difficult to maintain high rates of BSP. In previous school-based studies, VPF has been collected by researchers and provided to targeted teaching staff. In the current study, rather than relying on researchers, the authors used staff instructors to collect VPF and assessed how that experience influenced the instructors' use of BSP. Results suggest that VPF provided, on average, a doubling in rates of BSP use by directly targeted staff and more than a 50% increase in rates of BSP in nontargeted instructors who collected BSP data. Furthermore, three of the four participants had substantially higher praise-to-correction ratios during the VPF intervention when compared with baseline and reversal conditions. Implications for improving treatment fidelity and reducing supervision time are discussed.

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.

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.