Behavioral Approaches to Training Developmentally Disabled Children for an Overnight EEG Procedure.

Smith-Lemli-Opitz syndrome (SLOS) is a genetic syndrome associated with multiple congenital malformations, mental retardation, and autism spectrum behaviors. This clinical protocol was part of a larger study investigating the effects of a cholesterol-lowering medication for SLOS patients. Behavioral therapists were consulted to facilitate participants' cooperation with an overnight electroencephalogram (EEG). Seventeen children participated in one 1-hour training session of a mock EEG. Behavioral methods included task analysis, differential reinforcement, and escape extinction. Descriptive data reveal low cognitive and adaptive functioning. Fifty three percent of children tolerated all steps of the training procedure and 88% of participants tolerated all of the actual EEG procedure. Behavioral methods of training children may be an effective preparation for EEG procedures for children with SLOS. This study indicates that sedation, anesthesia, or restraints are not necessary to accomplish EEG testing of children with SLOS. Results may generalize to children with a range of disabilities.

Teaching children with attention deficit hyperactivity disorder (ADHD) and autistic disorder (AD) how to swallow pills.

One barrier to medication adherence in pediatric populations is difficulty swallowing pills. Some children may not have prerequisite skills for pill swallowing, while others may have developed conditioned anxiety from repeated negative experiences. Eight children with attention deficit hyperactivity disorder or autistic disorder participated in behavioral training to increase cooperation with pill swallowing. A pill-swallowing protocol was utilized during practice sessions with placebo "pills" of increasing size to implement systematic desensitization. Seven of the 8 children swallowed medication with a therapist. Six of the 8 children maintained treatment gains over time. Interventions used to succeed with these children are presented along with methods to reduce conditioned behavioral distress.

Behavioral training for pill-swallowing difficulties in young children with autistic disorder.

INTRODUCTION: Difficulty with swallowing pills is a common problem, leading to noncompliance with treatment recommendations. Many young children with autistic disorder (AD) who also show comorbid symptoms associated with attention deficit hyperactivity disorder (ADHD) have difficulty swallowing pills. This pilot study describes our experience in teaching pill-swallowing skills to 4 children with AD who also had comorbid symptoms associated with ADHD. METHODS: Four children, aged 5-;6.5 years, were enrolled for pill-swallowing training, 3 of the children were Caucasian boys and 1 child was a Hispanic girl. All children met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for AD and ADHD-like symptoms. The children's verbal IQ ranged from 54-96, their nonverbal IQ ranged from 85-107, and the Preschool Language Scale-3 total language score ranged from 50-98. RESULTS: At the end of the pilot study, 2 children (50%) successfully learned to swallow the study capsules, 1 child (25%) was able to swallow the study capsules with the behavior therapist but had difficulty with the caregiver, and 1 child (25%) made slow progress and was withdrawn by the caregiver in favor of proceeding with a crushable medication for clinical care. CONCLUSION: Caregivers were appreciative of the opportunity for this short intervention. Behavioral training for pill swallowing may be indicated in some circumstances in young children with AD and/or other developmental disorders.

Improving pediatric compliance with positive airway pressure therapy: the impact of behavioral intervention.

STUDY OBJECTIVE: The purposes of this study were (1) to describe behavior interventions provided to improve compliance with positive airway pressure (PAP) therapies in children with obstructive sleep apnea, (2) to survey physician and caregiver satisfaction with these interventions, and (3) to present preliminary outcome data on the effects of these interventions. DESIGN: Retrospective, descriptive analysis. SETTING: Pediatric psychology consultation service at a university-affiliated rehabilitation hospital. PARTICIPANTS: 20 children (aged 1-17 years) with obstructive sleep apnea, referred by physicians for noncompliance with PAP. INTERVENTIONS: Patients self-selected into 1 of 3 groups: (1) a group receiving a 1.5-hour consultation and recommendation session (CR+), (2) a group receiving consultation and recommendations plus a course of behavior therapy (BT), and (3) a group for whom behavior therapy was recommended after the consultation and recommendations, but the family did not follow-up (CR-). RESULTS: Prior to behavior intervention, none of the children were consistently wearing the PAP equipment. After intervention, 75% of children who received behavior intervention (CR+ and BT groups) successfully tolerated PAP with increased hours of documented usage. This was in contrast to children whose families declined recommended behavior therapy (CR- group), of whom 0% increased their usage of PAP. High satisfaction ratings were obtained from referring physicians and patient caregivers for children in the CR+ and BT groups. CONCLUSIONS: The results are encouraging and support the importance of behavior analysis and therapy for increasing compliance and making the benefits of PAP available to a greater number of children.