A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities.

Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.

Adherence to treatment in a behavioral intervention curriculum for parents of children with autism spectrum disorder.

Parents (N = 21) of children with autism spectrum disorders responded to a survey on adherence to skills instruction and problem behavior management strategies they had previously been observed to master in a standardized training curriculum based on the principles of applied behavior analysis. Survey items were guided by existing models of and research in treatment adherence. Parents reported adherence below observed mastery criteria in five of six skill areas. Three independent variables indexing caregiver perception were significantly correlated with reported adherence: perceived effectiveness as a behavior change agent, confidence in the intervention to produce meaningful change, and acceptance of child in family and community. Perceived confidence significantly predicted adherence in a regression model (p < .05). Implications of caregiver perception in explanatory frameworks for adherence are discussed, and next steps in the measurement and study of treatment adherence in behavior analysis are proposed.

Functional analysis and treatment of self-injurious behaviour in a young child with traumatic brain injury.

PRIMARY OBJECTIVE: There has been no research evaluating the utility of functional analysis (FA) in identifying effective interventions for severe problem behaviour in very young children with traumatic brain injury (TBI). It was hypothesized that FA technology would be applicable for this population and facilitate effective intervention development. RESEARCH DESIGN: A within-subject A-B-A reversal design was used to evaluate a functional communication training (FCT) intervention. This design allows for a demonstration of experimental control of the intervention over behaviour in single-case research. METHODS AND PROCEDURE: The authors conducted an FA of self-injurious behaviour (SIB) in an 18-month old boy with TBI. Results of the FA suggested that SIB was maintained, at least in part, by contingent maternal attention. An FCT intervention was used to teach a request for attention using an alternative communication device. MAIN OUTCOMES AND RESULTS: The FCT intervention reduced SIB to near zero and resulted in consistent use of an alternative communication device, functionally replacing SIB with desirable behaviour. The child's mother was coached to conduct all treatment sessions and reported satisfaction with the process. CONCLUSION: Analysis of behavioural function may play an important role in developing effective interventions for very young TBI patients with behaviour problems.

Adherence to behavioral and medical treatment recommendations by parents of children with autism spectrum disorders.

The extent to which parents of children with intellectual or developmental disabilities are adherent to prescribed treatments has not been investigated. In this treatment adherence study, parents (n = 220) of children with autism spectrum disorders were surveyed regarding implementation of recommended treatments to manage problem behavior of their children living at home. Overall adherence to medical treatment recommendations was significantly greater than adherence to behavioral treatment recommendations (p < .002). Of the behavioral treatment recommendations, parents reported greater adherence to reinforcement (81.7%) than punishment (68.9%). Child diagnosis (p < .002) and the diagnosis x marital status interaction (p < .05) were significantly associated with reported adherence to behavioral and medical treatment, respectively. Results are discussed in light of the need to address adherence enhancement and measurement methods.

Computed tomographic coronary angiography: experience at Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital.

Noninvasive cardiac computed tomographic imaging using multislice or electron beam technology has been shown to be highly specific and sensitive in diagnosing coronary heart disease. It is about a fifth of the cost of coronary angiography and is particularly well suited for evaluating patients with a low or low to moderate probability of having obstructive coronary atherosclerosis. In addition, it offers more information than calcium scoring: because of the intravenous contrast used, it temporarily increases the density of the lumen and allows differentiation of soft plaque from calcified plaque. The Baylor Hamilton Heart and Vascular Hospital now uses this modality to define coronary atherosclerosis in patients who would otherwise have needed invasive coronary angiography; several research protocols with the technique are also under way. Baylor has recently upgraded to the 64-slice scanner. It is expected that computed tomographic coronary angiography will replace a significant percentage of invasive cardiac catheterizations.