A Behavior-Analytic Approach to Antivaccination Practices.

In recent years, there has been an increase in outbreaks of diseases that are preventable by vaccination. As vaccination involves behavior, behavior analysts are uniquely positioned to contribute solutions to this socially significant problem. The present article explores a behavior-analytic approach to understanding the function of the behavior of both people who have their children vaccinated and those who do not have their children vaccinated, and potential interventions to increase vaccination rates. An introduction to the problem is followed by a brief history of the antivaccination movement. In our analysis, a failure to vaccinate is conceptualized as a noncompliance response (i.e., medical nonadherence), and conditions giving rise to that noncompliance are evaluated. In this process, the roles of avoidance, the functional-altering impact of rule-governed behavior, relational frames, and countercontrol are considered. Potential solutions informed by applied behavior-analytic literature, including contingency management and behavioral safety, are discussed.

Does Anxiety Modify the Risk for, or Severity of, Conduct Problems Among Children With Co-Occurring ADHD: Categorical and Dimensional and Analyses.

OBJECTIVE: The goal was to examine whether anxiety modifies the risk for, or severity of, conduct problems in children with ADHD. METHOD: Assessment included both categorical and dimensional measures of ADHD, anxiety, and conduct problems. Analyses compared conduct problems between children with ADHD features alone versus children with co-occurring ADHD and anxiety features. RESULTS: When assessed by dimensional rating scales, results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety are at risk for more intense conduct problems. When assessment included a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis via the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic Version (K-SADS), results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety neither had more intense conduct problems nor were they more likely to be diagnosed with oppositional defiant disorder or conduct disorder. CONCLUSION: Different methodological measures of ADHD, anxiety, and conduct problem features influenced the outcome of the analyses.

A Flow Chart of Behavior Management Strategies for Families of Children with Co-Occurring Attention-Deficit Hyperactivity Disorder and Conduct Problem Behavior.

Behavioral parent training is an evidence-based treatment for problem behavior described as attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. However, adherence to treatment fidelity and parent performance of the management skills remains an obstacle to optimum outcome. One variable that may limit the effectiveness of the parent training is that demanding behavior management procedures can be deceptively complicated and difficult to perform. Based on outcome research for families of children with co-occurring ADHD and conduct problem behavior, an example of a visual behavior management flow chart is presented. The flow chart may be used to help teach specific behavior management skills to parents. The flow chart depicts a chain of behavior management strategies taught with explanation, modeling, and role-play with parents. The chained steps in the flow chart are elements common to well-known evidence-based behavior management strategies, and perhaps, this depiction well serve as a setting event for other behavior analysts to create flow charts for their own parent training, Details of the flow chart steps, as well as examples of specific applications and program modifications conclude.

The Development of Comorbid Conduct Problems in Children With ADHD: An Example of an Integrative Developmental Psychopathology Perspective.

OBJECTIVE: We describe interactions among factors that contribute to the development of conduct problems among children with ADHD. METHOD: An integrative developmental psychopathology analysis combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD. RESULTS: Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child's conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory. CONCLUSION: In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems.

Can we prevent smoking in children with ADHD: a review of the literature.

UNLABELLED: Cigarette smokers pose public health challenges and are over-represented among individuals with attention deficit hyperactivity disorder (ADHD). This article reviews the link between ADHD and smoking across various developmental stages with an emphasis on factors that interact with ADHD (e.g., comorbidity with conduct disorder) to modify risk for nicotine dependence from childhood through adulthood. METHOD: A literature review was conducted for 2000-2009 using key words ADHD, smoking, adolescents, adulthood. RESULTS: Childhood, adolescent and adult ADHD all increase risk for smoking. Childhood ADHD increases risk for early smoking during adolescence, particularly if untreated and in combination with conduct disorder (CD). Attention deficit hyperactivity disorder in adolescence increases the risk of daily smoking in adulthood. These findings underscore the importance of smoking prevention for children and adolescents with ADHD and other risk factors (e.g., CD). Pharmacotherapy for ADHD offers promise to lower the risk of smoking during adolescence. Preventing the development of conduct disorder (CD) or controlling the symptoms of CD is also possible and may reduce smoking and associated outcomes.

ADHD: does parenting style matter?

Attention deficit hyperactivity disorder (ADHD) is a condition typically arising in childhood, which untreated, can have consequences reaching into adolescence and beyond. Effective pharmacological treatment is available and has become widespread in the West. Outcomes for both the child with ADHD and the parent may be influenced by the nature of interaction between them. The authors of this article aim to review published research examining the interaction between parents and their children with ADHD. A PubMed search was conducted of studies written in English between 2000 and 2007 with the keywords ADHD and parenting. Child ADHD elicits high levels of parental stress and maladaptive parenting. The presence of parental psychopathology is common and influences the parent's response to the child's ADHD symptoms. Optimizing parent-child interaction and parental psychiatric status may improve outcomes for both parent and child.

The outcome of group parent training for families of children with attention-deficit hyperactivity disorder and defiant/aggressive behavior.

The effects of group parent training on parent behavior, and on the behavior of 45 children with attention-deficit hyperactivity disorder and defiant aggressive behavior, were evaluated with a pre-post design. Parent training included didactics on the features and etiology of ADHD and its relationship to defiant/aggressive behavior, as well as parenting skills that adhered to parameters established in the Behavior Management Flow Chart (BMFC). The logic that guided the construction of the program and the unique aspects in the form and content of the parent training are identified. Outcome data show that training reduced childrens' hyperactive, defiant, and aggressive behavior, improved parenting behavior, and reduced parent stress. These data are comparable to previous outcome research evaluating the efficacy of parent training with the BMFC. The advantages of programs that are efficacious in group settings are discussed.

The relation between parental coping styles and parent-child interactions before and after treatment for children with ADHD and oppositional behavior.

This study examined the relation between parental coping styles, discipline, and child behavior before and after participating in a parent training program for parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior. For mothers, use of more maladaptive and less adaptive coping styles was related to more self-reported lax and overreactive discipline, more observed coercive parenting, and more observed child misbehavior prior to parent training. No significant relations were found for mothers following parent training after controlling for pretreatment variables. For fathers, use of more maladaptive and less adaptive coping styles was related to self-reported lax discipline before and after parent training. Contrary to prediction, fathers who reported less seeking support and adaptive-focused coping showed the most improvement in their children's behavior. Most results remained significant after controlling for self-reported depression. Implications for improving parent training research and programs were discussed.

Altering the function of commands presented to boys with oppositional and hyperactive behavior.

Mentalistic and behavioral analyses of noncompliance among children with hyperactive behavior are contrasted. Then, a behavioral training program for 3 boys with behavior characteristic of attention deficit hyperactivity disorder and oppositional defiant disorder is described. The child-focused training was conducted in conjunction with parent training. In an effort to increase the rate of compliance, the child-training program was designed to alter the function of parent commands by teaching the boys to verbalize rules about parent commands and consequences in the context of observing parent-child role-plays. Training was conducted within a multiple baseline design across children. Direct observation of mother-child interactions, telephone interviews, and standardized rating scales showed that training resulted in clinically significant reductions in noncompliance and improved parenting behavior. A 6-month follow-up revealed stable outcomes.