Impact of post-stroke aphasia on functional communication, quality of life, perception of health and depression: A case-control study.

BACKGROUND AND PURPOSE: Post-stroke aphasia is associated with a reduced quality of life (QoL) and higher risk of depression. Few studies have addressed the effect of coping with aphasia. Our aim is to evaluate the impact of post-stroke aphasia on self-reported QoL and symptoms of depression. METHODS: This was a cross-sectional prospective case-control study. Cases involved patients with post-stroke aphasia included in the DULCINEA trial (NCT04289493). Healthy controls were recruited using snowball sampling. All subjects completed the following questionnaires: General Health Questionnaire (GHQ-12), Stroke Aphasia Quality of Life Scale (SAQOL-39), Communicative Activity Log (CAL) and Stroke Aphasic Depression Questionnaire (SADQ-10). RESULTS: Twenty-three patients (eight women; mean age 62.9 years) and 73 controls (42 women; mean age 53.7 years) were included. Cases scored lower than controls in perception of health (GHQ-12: median 3 [IQR 1; 6] vs. 0 [IQR 0; 2]) and perception of QoL (SAQOL-39: median 3.6 [IQR 3.3; 40] vs. 4.6 [IQR 4.2; 4.8]). Functional communication (CAL: median 135 [IQR 122; 148] vs. 94 [IQR 74; 103]) and SAQOL-39 communication subscale (median 2.7 [IQR 2.1; 3.2] vs. 4.8 [IQR 4.6; 5.0]) were also significantly lower in the case group. Notably, cases reported fewer depressive symptoms than controls (SADQ-10: median 11 [IQR 9; 15] vs. 13 [IQR 11; 16]; p = 0.016). A mediational analysis revealed that the relationship between post-stroke aphasia and depression was not mediated by functional communication. CONCLUSIONS: Although communication difficulties impact the QoL of patients with post-stroke aphasia, such patients report fewer depressive symptoms on the SADQ-10 scale than healthy people, with no differences in scores related to social participation.

Correction: Professional Development of Behavior Analysts in Europe: A Snapshot for 21 Countries.

[This corrects the article DOI: 10.1007/s40617-022-00754-0.].

Quantitative Indices of Student Social Media Engagement in Tertiary Education: A Systematic Review and a Taxonomy.

Recent studies have evaluated the use of social media as learning aids in tertiary education. Emerging research in this area has focused primarily on non-quantitative approaches to student social media engagement. However, quantitative engagement outcomes may be extracted from student posts, comments, likes, and views. The goal of the present review was to provide a research-informed taxonomy of quantitative and behavior-based metrics of student social media engagement. We selected 75 empirical studies comprising a pooled sample of 11,605 tertiary education students. Included studies used social media for educational purposes and reported student social media engagement outcomes (source databases: PsycInfo and ERIC). We used independent raters and stringent interrater agreement and data extraction processes to mitigate bias during the screening of references. Over half of the studies (52%, n = 39) utilized ad hoc interviews and surveys to estimate student social media engagement, whereas thirty-three studies (44%) used some form of quantitative analysis of engagement. Based on this literature, we present a selection of count-based, time-based, and text-analysis metrics. The proposed taxonomy of engagement metrics resulting provides the methodological basis for the analysis of social media behavior in educational settings, particularly, for human operant and behavioral education studies. Implications for future research are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10864-023-09516-6.

Reducing face touching through haptic feedback: A treatment evaluation against fomite-mediated self-infection.

Fomite-mediated self-infection via face touching is an understudied transmission pathway for infectious diseases. We evaluated the effect of computer-mediated vibrotactile cues (presented through experimental bracelets located on one or both hands of the participant) on the frequency of face touching among eight healthy adults in the community. We conducted a treatment evaluation totaling over 25,000 min of video observation. The treatment was evaluated through a multiple-treatment design and hierarchical linear modeling. The one-bracelet intervention did not produce significantly lower levels of face touching across both hands, whereas the two-bracelet intervention did result in significantly lower face touching. The effect increased over repeated presentations of the two-bracelet intervention, with the second implementation producing, on average, 31 fewer face-touching percentual points relative to baseline levels. Dependent on the dynamics of fomite-mediated self-infection via face touching, treatment effects could be of public health significance. The implications for research and practice are discussed.

Accuracy of paper-and-pencil systematic observation versus computer-aided systems.

Computer-aided behavior observation is gradually supplanting paper-and-pencil approaches to behavior observation, but there is a dearth of evidence on the relative accuracy of paper-and-pencil versus computer-aided behavior observation formats in the literature. The current study evaluated the accuracy resulting from paper-and-pencil observation and from two computer-aided behavior observation methods: The Observer XT® desktop software and the Big Eye Observer® smartphone application. Twelve postgraduate students without behavior observation experience underwent a behavior observation training protocol. As part of a multi-element design, participants recorded 60 real clinical sessions randomly assigned to one of the three observation methods. All three methods produced high levels of accuracy (paper-and-pencil, .88 ± .01; The Observer XT, .84 ± .01; Big Eye Observer, .84 ± .01). A mixed linear model analysis indicated that paper-and-pencil observation produced marginally superior accuracy values, whereas the accuracy produced by The Observer XT and Big Eye Observer did not differ. The analysis suggests that accuracy of recording was mediated by the number of recordable events in the observation videos. The implications of these findings for research and practice are discussed.

Professional Development of Behavior Analysts in Europe: A Snapshot for 21 Countries.

Behavior analysts are not recognized or regulated as a distinct profession in Europe. For the most part, European behavior analysts adhered to the standards set by the U.S.-based Behavior Analyst Certification Board (BACB). However, the BACB certification has not been recognized officially in any European jurisdiction. The recent decision by the BACB to discontinue eligibility of non-U.S. residents to apply for the BCBA exam by the end of 2022 has brought the issue of professional regulation outside of the United States into sharp focus. This article offers a snapshot in time of professional recognition of behavior analysts in 21 European countries. It stems from the Erasmus+ funded EuroBA project and its Professional Advisory Group (PAG). The EuroBA project aims to develop common standards and competences for behavior analysts to facilitate national regulation and mutual recognition across Europe.

Social referencing training in children with autism spectrum disorder: A randomized controlled study.

Children with autism spectrum disorder (ASD) have been shown to exhibit fewer instances of social referencing compared to their typically developing peers. The current study evaluated the effectiveness of multiple-exemplar training, prompting, and social reinforcement to teach social referencing. We used a single-blind randomized control trial with a multiple-baseline design nested within the experimental group to evaluate treatment effects. Twenty-five children with ASD participated. Participants in the treatment group showed significantly higher social referencing scores. However, there were no statistically significant differences between the groups in the posttraining initiating and responding to joint attention scores. The clinical implications of our findings are discussed.

A callosal biomarker of behavioral intervention outcomes for autism spectrum disorder? A case-control feasibility study with diffusion tensor imaging.

Tentative results from feasibility analyses are critical for planning future randomized control trials (RCTs) in the emerging field of neural biomarkers of behavioral interventions. The current feasibility study used MRI-derived diffusion imaging data to investigate whether it would be possible to identify neural biomarkers of a behavioral intervention among people diagnosed with autism spectrum disorder (ASD). The corpus callosum has been linked to cognitive processing and callosal abnormalities have been previously found in people diagnosed with ASD. We used a case-control design to evaluate the association between the type of intervention people diagnosed with ASD had previously received and their current white matter integrity in the corpus callosum. Twenty-six children and adolescents with ASD, with and without a history of parent-managed behavioral intervention, underwent an MRI scan with a diffusion data acquisition sequence. We conducted tract-based spatial statistics and a region of interest analysis. The fractional anisotropy values (believed to indicate white matter integrity) in the posterior corpus callosum was significantly different across cases (exposed to parent-managed behavioral intervention) and controls (not exposed to parent-managed behavioral intervention). The effect was modulated by the intensity of the behavioral intervention according to a dose-response relationship. The current feasibility case-control study provides the basis for estimating the statistical power required for future RCTs in this field. In addition, the study demonstrated the effectiveness of purposely-developed motion control protocols and helped to identify regions of interest candidates. Potential clinical applications of diffusion tensor imaging in the evaluation of treatment outcomes in ASD are discussed.

Functional analysis patterns of automatic reinforcement: A review and component analysis of treatment effects.

Functional analysis (FA) conditions include different antecedent or consequent events that may disrupt responding. Thus, varying patterns of FA differentiation may predict treatment outcomes of problem behavior maintained by automatic reinforcement. These patterns could be used to inform the development of individualized interventions. An approach to classifying these patterns is to categorize FA outcomes as attention condition lowest, demand condition lowest, and play condition lowest, according to the condition in which problem behavior is most disrupted. In Study 1, we applied this criterion to 120 datasets finding that 60% could be classified using this method, whereas 89% of datasets showed a disruption of 50% or higher. In Study 2, we conducted a treatment component analyses for 3 individuals whose FAs each exhibited one of the 3 distinct patterns. The results indicated that specific elements of the FA conditions could reduce problem behavior. The predictive utility of these disruption patterns is discussed.

DUbbing Language-therapy CINEma-based in Aphasia post-Stroke (DULCINEA): study protocol for a randomized crossover pilot trial.

BACKGROUND: Communication is one of the most important predictors of social reintegration after stroke. Approximately 15-42% of stroke survivors experience post-stroke aphasia. Helping people recover from aphasia is one of the research priorities after a stroke. Our aim is to develop and validate a new therapy integrating dubbing techniques to improve functional communication. METHODS: The research project is structured as three work packages (WP). WP1: development of the dubbed language cinema-based therapy: Two research assistants (a speech therapist and a dubbing actor) will select the clips, mute specific words/sentences in progressive speech difficulty, and guide patients to dub them across sessions. Words to be dubbed will be those considered to be functionally meaningful by a representative sample of aphasic patients and relatives through an online survey. WP2: a randomized, crossover, interventional pilot study with the inclusion of 54 patients with post-stroke non-fluent aphasia. Patients will be treated individually in 40-min sessions twice per week for 8 weeks. Primary outcomes will be significant pre/post differences in scores in the Communicative Activity Log (CAL) questionnaire and Boston Diagnostic Aphasia Examination (BDAE) administered by a psychologist blinded to the patients' clinical characteristics. SECONDARY OUTCOMES: General Health Questionnaire (GHQ)-12, Stroke Aphasia Quality of Life Scale (SAQOL-39), Western Aphasia Battery Revised (WAB-R), and the Stroke Aphasic Depression Questionnaire (SADQ10). WP3: educational activities and dissemination of results. WP3 includes educational activities to improve public knowledge of aphasia and dissemination of the results, with the participation of the Spanish patients' association Afasia Activa. DISCUSSION: This pilot clinical trial will explore the efficacy of a new therapeutic tool based on dubbing techniques and computer technology to improve functional communication of patients suffering from post-stroke aphasia with the use of standardized test assessment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04289493 . Registered on 28 February 2020.

Toward an experimental analysis of verbal shaping in psychotherapy.

AbstractObjective. Some authors have suggested that verbal shaping is an active component in cognitive restructuring. The goal of the current study was to provide experimental evidence in support of the shaping hypothesis. METHOD: Three consecutively admitted adults with symptoms of anxiety and depression participated in the study. Participants underwent baseline, treatment comparison, crossover, and follow-up phases as part of an experimental single-case study. We selected two target irrational beliefs and praised either the client's approximations to a terminal (more adaptive) class of verbalizations (differential reinforcement of approximations) or just the terminal class of verbalizations (terminal reinforcement). RESULTS: Irrational beliefs exposed to differential reinforcement of approximations was a more effective approach to reducing irrational beliefs. CONCLUSION: The study provides experimental evidence in support of the verbal shaping hypothesis. Our findings suggest that it may be possible to enhance clinical outcomes by actively engaging in verbal shaping during client-therapist verbal interaction.

Long-term functional stability of problem behavior exposed to psychotropic medications.

Psychopharmacological and behavioral interventions are often combined in the treatment of problem behavior in people with intellectual and developmental disability (IDD). However, little is known about the interaction between medication pharmacodynamics and behavior function. A better understanding of these mechanisms could serve as the conceptual foundation for combined interventions. The current analysis is a systematic replication of Valdovinos et al. (2009). We conducted continuous functional analyses within analogue reversal and parametric analyses monitoring the impact of various dosages of primarily antipsychotic medications on problem behavior and its function. Four individuals with IDD and problem behavior who were also receiving psychotropic medications participated. Medication adjustments produced small to negligible decreases in problem behavior, and behavior function remained largely unchanged through the 14 medication adjustments evaluated. The continuous functional analysis helped to identify what could be delayed medication effects on problem behavior. The clinical and methodological implications of this replication are discussed.

Extending a misallocation model to children's choice behavior.

Nonhuman animal models show that reinforcers control behavior through what they signal about the likelihood of future events, but such control is generally imperfect. Imperfect control by the relation between past and likely future events may result from imperfect detection of those events as they occur, which result in imperfect detection of the relation between events. Such an approach would suggest the involvement of more complex psychological processes like memory in simple operant learning. We extended a research paradigm previously examined with nonhuman animals to test the ability of a quantitative model that assumes imperfect control by the relation between events arises because of (a) occasional misallocation of reinforcers to the wrong response, causing imperfect control by the relation between events; and (b) a tendency to explore or exploit which is independent of the relation between events. Children played a game in which one of two different responses could produce a reinforcer. The likelihood of a reinforcer for the same response that produced the last one varied across three conditions (.1, .5, .9). As with nonhuman animal models, children's choices followed these probabilities closely but not perfectly, suggesting strong control by what one reinforcer signals about subsequent reinforcers. Choice was well described by the quantitative model. This same model also provides a good description of nonhuman animal-model data, suggesting fundamentally similar mechanisms of control across species. These findings suggest reinforcers control behavior to the extent the relation between reinforcers can be detected-that is, simple operant learning may be more complex than is typically assumed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Electromyography of diurnal bruxism during assessment and treatment.

Diurnal bruxism among individuals with intellectual disabilities is often measured on the basis of its auditory products, thereby precluding the contingent presentation of stimuli during silent bruxism events. Electromyography (EMG) offers a technological solution to the identification of all bruxism events. EMG has not been previously evaluated in nonvocal clients with intellectual disabilities in the context of functional analysis and treatment. In the current series of analyses, we suggest a set of methods to implement EMG technology with this population. In Analysis 1, we propose a strategy for systematically identifying bruxism events. In Analysis 2 we evaluate an EMG staff-training package with naïve interventionists without past experience with EMG technology. Finally, Analysis 3 presents a practical example of this method during the functional analysis and treatment of a client with frequent diurnal bruxism.

Nathan H. Azrin: A Case Study in Research Translation in Behavior Science.

Nathan H. Azrin (1930-2013) contributed extensively to the fields of experimental and applied behavior analysis. His creative and prolific research programs covered a wide range of experimental and applied areas that resulted in 160 articles and several books published over a period of almost 6 decades. As a result, his career illustrates an unparalleled example of translational work in behavior analysis, which has had a major impact not only within our field, but across disciplines and outside academia. In the current article we present a summary of Azrin's wide ranging contributions in the areas of punishment, behavioral engineering, conditioned reinforcement and token economies, feeding disorders, toilet training, overcorrection, habit disorders, in-class behavior, job finding, marital therapy, and substance abuse. In addition, we use scientometric evidence to gain an insight on Azrin's general approach to treatment evaluation and programmatic research. The analysis of Azrin's approach to research, we believe, holds important lessons to behavior analysts today with an interest in the applied and translational sectors of our science. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40614-020-00278-4.

Telehealth mask wearing training for children with autism during the COVID-19 pandemic.

SARS-CoV-2 is the virus causing COVID-19 and is spread through close person-to-person contact. The use of face masks has been described as an important strategy to slow its transmission. We evaluated the effects of coaching caregivers via telehealth technologies to teach face mask wearing to children with autism spectrum disorder. Six participants with a history of challenging behavior associated with mask wearing were recruited from different parts of the world, and trained using graduated exposure, shaping, and contingent reinforcement. By the end of the intervention, all participants wore a face mask for a period of 10 min without exhibiting challenging behavior. The skills generalized to a novel mask or a community setting. Mask wearing did not affect the percentage of oxyhemoglobin saturation of participants, and caregivers found the intervention useful. The findings support previous tolerance training treatment evaluations in children with developmental disorders exhibiting resistance to healthcare routines.

Quantifying the effects of the differential outcomes procedure in humans: A systematic review and a meta-analysis.

We present a systematic review and a meta-analysis comparing the differential outcomes procedure to a nondifferential outcomes procedure among clinical and nonclinical populations. Sixty distinct experiments were included in the systematic review, 43 of which were included in the meta-analysis. We calculated pooled effect sizes for accuracy (overall accuracy, test accuracy, transfer accuracy) and acquisition outcomes (latency, errors, and trials to mastery). The meta-analysis revealed significant medium-to-large effect sizes for all three accuracy measures (pooled effect size range, 0.57 to 1.30). We found relatively greater effect sizes among clinical populations (effect size = 1.04). The single-subject experimental literature included in the systematic review was consistent with the findings from the group studies, demonstrating improvements in accuracy and speed of learning for the majority of participants. Moderator and subgroup analyses suggest that discrimination difficulty may induce relatively larger differential outcomes effects. The results indicate that the differential outcomes procedure can be a valuable addition to reinforcement-based interventions.

Evaluation of a Home-Based Behavioral Treatment Model for Children With Tube Dependency.

OBJECTIVE: To evaluate a home-based behavioral treatment model for children with tube dependency. METHODS: Nine children (aged 4-14 years) dependent on nasogastric and gastrostomy tubes were consecutively admitted into a home-based behavioral treatment program. A psychologist specializing in applied behavior analysis led the assessment and treatment phases with the support of caregivers and a multidisciplinary team. Caregivers participated in a caregiver training program and continued the intervention once the service was discontinued. We conducted follow-up visits up to 12 months after treatment. The program was evaluated with a multiple-baseline across participants design. We computed on-treatment and intention-to-treat effects according to the Hedges-Pustejovsky-Shadish model. We monitored behavioral (food acceptance and swallowing) and nutritional outcomes (body weight, oral intake, and tube intake), treatment acceptability and satisfaction, caregiver stress, and estimated treatment cost savings. RESULTS: Food acceptance, swallowing, oral intake, and tube intake demonstrated large treatment gains relative to pretreatment levels (effect size range of the intention-to-treat analysis = 0.74-2.1). All participants maintained or increased their body weight. Follow-up effect sizes indicated further improvements. By the final follow-up assessment, six out of the nine children had ceased tube feeding, and one had tube feeds reduced. Caregivers and health professionals provided strong ratings of treatment satisfaction. The cost-savings analysis suggested that a home-based treatment may be a cost-effective alternative to prolonged tube feeding as well as to other treatment approaches. CONCLUSIONS: This study provides evidence supporting home-based multicomponent behavioral interventions in the treatment of pediatric feeding disorders. CLINICAL TRIAL IDENTIFIER: ACTRN12614001127695, https://goo.gl/XSQ4ZH.

A protective personal factor against disability and dependence in the elderly: an ordinal regression analysis with nine geographically-defined samples from Spain.

BACKGROUND: Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders. METHODS: A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity). RESULTS: High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29-0.87) and dependence (OR = 0.33; 95% CI = 0.19-0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22-0.70 and OR = 0.39; 95%CI = 0.21-0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence. CONCLUSIONS: Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain.

Establishing motion control in children with autism and intellectual disability: Applications for anatomical and functional MRI.

Excessive motion makes magnetic resonance imaging (MRI) extremely challenging among children with autism spectrum disorder (ASD). The medical risks of sedation establish the need for behavioral interventions to promote motion control among children with ASD undergoing MRI scans. We present a series of experiments aimed at establishing both tolerance of the MRI environment and a level of motion control that would be compatible with a successful MRI. During Study 1, we evaluated the effects of prompting and contingent reinforcement on compliance with a sequence of successive approximations to an MRI using a mock MRI. During Study 2, we used prompting and progressive differential reinforcement of other behaviors (DRO) to promote motion control in a mock MRI for increasing periods of time. Finally, during Study 3, some of the participants underwent a real MRI scan while a detailed in-session motion analysis informed the quality of the images captured.