Behavioral gain following isolation of attention.

Stable sensory perception is achieved through balanced excitatory-inhibitory interactions of lateralized sensory processing. In real world experience, sensory processing is rarely equal across lateralized processing regions, resulting in continuous rebalancing. Using lateralized attention as a case study, we predicted rebalancing lateralized processing following prolonged spatial attention imbalance could cause a gain in attention in the opposite direction. In neurotypical human adults, we isolated covert attention to one visual field with a 30-min attention-demanding task and found an increase in attention in the opposite visual field after manipulation. We suggest a gain in lateralized attention in the previously unattended visual field is due to an overshoot through attention rebalancing. The offline post-manipulation effect is suggestive of long-term potentiation affecting behavior. Our finding of visual field specific attention increase could be critical for the development of clinical rehabilitation for patients with a unilateral lesion and lateralized attention deficits. This proof-of-concept study initiates the examination of overshoot following the release of imbalance in other lateralized control and sensory domains, important in our basic understanding of lateralized processing.

Closing the gap: unmet needs of individuals with impulsive aggressive behavior observed in children and adolescents.

Impulsive aggressive (IA, or impulsive aggression) behavior describes an aggregate set of maladaptive, aggressive behaviors occurring across multiple neuropsychiatric disorders. IA is reactive, eruptive, sudden, and unplanned; it provides information about the severity, but not the nature, of its associated primary disorder. IA in children and adolescents is of serious clinical concern for patients, families, and physicians, given the detrimental impact pediatric IA can have on development. Currently, the ability to properly identify, monitor, and treat IA behavior across clinical populations is hindered by two major roadblocks: (1) the lack of an assessment tool designed for and sensitive to the set of behaviors comprising IA, and (2) the absence of a treatment indicated for IA symptomatology. In this review, we discuss the clinical gaps in the approach to monitoring and treating IA behavior, and highlight emerging solutions that may improve clinical outcomes in patients with IA.

Impact of multiple co-occurring emotional and behavioural conditions on children with autism and their families.

BACKGROUND: Comorbid conditions are very common in children and adults with autism spectrum disorder (ASD) and can affect school performance, adaptive skills and peer relationships. Comorbid conditions place strain on the family as well as the individual with ASD. This project aimed to determine the affect of comorbid conditions over and above child and family characteristics. METHODS: The present authors examined 3,055 cases of children with ASD who had varying numbers of comorbid conditions (i.e., ADHD, depression, anxiety or behaviour problems). RESULTS: Multiple comorbid conditions did have a unique impact on difficulties accessing services. A greater number of comorbid conditions impacted daily activity participation, but not a family's receipt of mental health care or respite, work changes or number of weekly hours dedicated to caring for a child with ASD. CONCLUSIONS: Families, practitioners, paraprofessionals and educators of children with autism should address comorbid conditions to ensure both child and family well-being.

Noncontingent reinforcement for the treatment of severe problem behavior: An analysis of 27 consecutive applications.

Noncontingent reinforcement (NCR) is a commonly used treatment for severe problem behavior displayed by individuals with intellectual and developmental disabilities. The current study sought to extend the literature by reporting outcomes achieved with 27 consecutive applications of NCR as the primary treatment for severe problem behavior. All applications of NCR were included regardless of treatment outcome to minimize selection bias favoring successful cases. Participants ranged in age from 5 to 33 years. We analyzed the results across behavioral function and with regard to the use of functional versus alternative reinforcers. NCR effectively treated problem behavior maintained by social reinforcement in 14 of 15 applications, using either the functional reinforcer or alternative reinforcers. When we implemented NCR to treat problem behavior maintained by automatic reinforcement, we often had to add other treatment components to produce clinically significant effects (five of nine applications). Results provide information on the effectiveness and limitations of NCR as treatment for severe problem behavior.

Filling potholes on the implementation highway: Evaluating the implementation of Parent-Child Interaction Therapy in Los Angeles County.

In October 2012, first 5 LA funded a unique collaboration between Los Angeles County Department of Mental Health (DMH) and UC Davis PCIT Training Center (UCD PCIT) to train county-contracted agencies to provide Parent-Child Interaction Therapy (PCIT). This $20 million dollar, 5-year grant represented the largest implementation effort of an empirically based treatment to date. The purpose of this paper was to describe the first 2 years of the implementation process of this project, beginning with project start up and pre-implementation phases, and to present agency training and client performance outcomes from our first year of training. Results presented in this evaluation suggest that it is possible to train LA County providers in PCIT, and that PCIT is an effective intervention for DMH-contracted providers in LA County. This evaluation also discusses challenges to successful implementation. Barriers to progress included unanticipated delays building county infrastructure, trainee attrition, and insufficient client referrals. We discuss the results of the current implementation with respect to theory, research, and others' training models, with the aim of evaluating and prioritizing different implementation drivers, noting the ongoing competition between knowing what to do and the need for action.

Further evaluation of latency-based brief functional analysis methods: An evaluation of treatment utility.

OBJECTIVE: Objectives were to evaluate latency-based brief functional analysis (BFA) model for identifying functions of aberrant behavior and treatments generated based on the results of the latency-based brief functional analysis. METHODS: We conducted latency-based BFA, including contingency reversals, and function-based treatment evaluations, including non-contingent reinforcement (NCR) and differential reinforcement of alternative behavior (DRA) with three individuals with autism using single subject design methodology. RESULTS: Socially-mediated functions (attention; tangible) were indicated for two participants and an automatic function was identified for one participant. The treatments generated based on results of the BFA were effective at reducing aberrant behavior for all participants. CONCLUSIONS: Results provide additional support that latency-based BFA model has utility in (a) the identification of functions of aberrant behavior and (b) the generation of function-based treatments. These results suggest clinicians who encounter setting and client-specific constraints (e.g. time; severity of aberrant behavior) have additional flexibility in choosing assessment tools.

Research opportunities in the area of mental health promotion, prevention, and intervention for children and youth.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on mental health promotion, prevention, and intervention for children and youth. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from AOTA's Occupational Therapy Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

Decreasing excessive functional communication responses while treating destructive behavior using response restriction.

Functional communication training (FCT) is an established treatment for destructive behavior that missucceeds in about 37% of cases when the reinforcement schedule for the functional communication response (FCR) is thinned using multiples schedules (mult FCT; Hagopian, Boelter, & Jarmolowicz, 2011). In this investigation, we evaluated the use of response restriction FCT (RR FCT) in a cohort of patients with poorly differentiated responding of the FCR during mult FCT. Results showed that (a) RR FCT maintained high rates of correct FCRs during the reinforcement component of RR FCT without increasing destructive behavior; (b) children displayed highly discriminated FCRs when an FCR card and a control card were simultaneously available during the reinforcement component of RR FCT; and (c) near-zero rates of destructive behavior were observed during the last five sessions of the terminal reinforcement schedule. Results are discussed relative to differences between mult FCT and RR FCT and successive and simultaneous discriminations.

Using tablet assisted Social Stories™ to improve classroom behavior for adolescents with intellectual disabilities.

The present study examined the use of tablet assisted Social Stories™ intervention for three high school students with severe intellectual disabilities whose problem behavior interfered with their learning and caused classroom disruptions. A multiple probe design across participants was employed to test the impact of the tablet assisted SS on the participants' target behaviors. During intervention, the participants read the Social Stories that were created on Prezi and accessed via Quick Response (QR) codes using a Galaxy Tap smart tablet before participating in an academic period. Data indicated that the SS intervention decreased disruptive behavior and increased academic engagement in all three participants. All three demonstrated generalization of behaviors to a nontargeted academic period and maintenance of improved behaviors at the 2-week follow-up.

Encouraging positive behavior in 'challenging' children: the Nurtured Heart Approach.

Conventional parenting approaches often fall short of the mark for children who exhibit difficult behavior, sometimes inadvertently leading to increased oppositionality and poor self-esteem. As a result, parents of children with intense personalities and challenging behaviors need strategies that work very differently. The Nurtured Heart Approach is a philosophy/technique developed to help parents rewrite the often negative parenting scripts used with these children by limiting the amount of attention given to negative or undesirable behaviors while noticing and acknowledging even small positive behaviors, naming them, "energizing" attention given to them, and valuing their occurrence. Although there has been very limited empirical study of the Nurtured Heart Approach to date, it has been used, with anecdotal reports of success, in a variety of settings, including Head Start programs, schools, foster care agencies, a treatment center, and a pre-adolescent diversion program (Glasser, 2000).

A randomized controlled trial of group Stepping Stones Triple P: a mixed-disability trial.

Stepping Stones Triple P (SSTP) is a parenting program designed for families of a child with a disability. The current study involved a randomized controlled trial of Group Stepping Stones Triple P (GSSTP) for a mixed-disability group. Participants were 52 families of children diagnosed with an Autism Spectrum Disorder, Down syndrome, Cerebral Palsy, or an intellectual disability. The results demonstrated significant improvements in parent-reported child behavior, parenting styles, parental satisfaction, and conflict about parenting. Results among participants were similar despite children's differing impairments. The intervention effect was maintained at 6-month follow-up. The results indicate that GSSTP is a promising intervention for a mixed-disability group. Limitations of the study, along with areas for future research, are also discussed.

Treatment challenges with profound behaviour disturbance after traumatic brain injury: a case report.

BACKGROUND: Severe behavioural disturbances exhibited during the earliest stages of recovery from severe traumatic brain injury often limit the ability to provide standard care. Studies that focus on treatment options for inpatients with such behaviours are scarce. There is limited guidance on how to approach therapy that will maximize the patient's tolerance and participation and how to measure meaningful progress. CASE REPORT: This case study describes how the use of an innovative treatment approach to improve attention was beneficial in rehabilitation of a patient with severe traumatic brain injury whose profound behaviour disturbances substantially precluded participation in traditional therapies. The study shows how rehabilitation utilizing an interactive virtual reality-robotics environment that minimized distractions was associated with improved engagement in therapy, decreased disruptive behaviour during treatment and more sensitive measurement of progress. CONCLUSION: These results may be instructive in how technology can be used to modify therapy sessions to make them accessible to patients with profound behaviour disturbance and how meaningful progress can be measured even in the absence of gains in traditional metrics.

A pilot study of parent training in young children with autism spectrum disorders and disruptive behavior.

Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders (ASDs) is limited. We present feasibility and initial efficacy data on a structured parent training program for 16 children (ages 3-6) with ASD and disruptive behavior. The 6-month intervention included 11 Core and up to 2 Optional sessions. The program was acceptable to parents as evidenced by an attendance rate of 84 % for Core sessions. Fourteen of 16 families completed the treatment. An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24. Using last observation carried forward, the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 (SD = 9.21) to 7.38 (SD = 6.15).

Prevalence of oppositional defiant disorder in a sample of Spanish schoolchildren

The aim of this study is to determine the prevalence rate of ODD in school age children, and analyze the variability of the prevalence rates per informant, according to the sources of information, sex, age, and level of agreement between teachers and parents. This is an epidemiological study conducted using a community sample extracted by means of multi-stage stratified sampling. The sample consisted of 1,295 children of both sexes from 6 to 8 years old. For diagnostic evaluation, the Oppositional Defiant Disorder Rating Scale (ODDRS-IV) was used. The estimated global prevalence of ODD, detected by all sources is 16.1%. But if we consider the percentage of subjects detected by only one informant, the prevalence rate is 9.5%. The prevalence according to teachers is 5.1% (95% CI = 3.88–6.31), according to fathers is 9% (95% CI = 7.38–10.54), and according to mothers is 9.7% (95% CI = 8.02–11.29). Teachers report more boys with ODD than girls. Results support the idea of high variability in ODD prevalence rates. Our findings suggest that parents are more prone to detect the disorder than teachers, and that boys present ODD more frequently than girls, only when they are evaluated by their teachers (AU)

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Differential effects of seating arrangements on disruptive behavior of fifth grade students during independent seatwork.

We investigated teacher versus student seat selection in the context of group and individual seating arrangements. Disruptive behavior during group seating occurred at twice the rate when students chose their seats than when the teacher chose. During individual seating, disruptive behavior occurred more than three times as often when the students chose their seats. The results are discussed in relation to choice and the matching law.

Correspondence between traditional models of functional analysis and a functional analysis of manding behavior.

Functional analysis procedures have been effectively used to determine the maintaining variables for challenging behavior and subsequently develop effective interventions. However, fear of evoking dangerous topographies of maladaptive behavior and concerns for reinforcing infrequent maladaptive behavior present challenges for people working in applied settings. The present investigation sought to evaluate the utility of an adjunctive functional analysis model that involved the reinforcement of mands rather than problem behavior and compared the results to traditional functional analyses. The results from the manding analysis yielded results similar to the traditional FA in 3 of 4 cases. These findings suggest that manding analyses may represent a useful assessment tool for difficult to assess problem behavior or for individuals in settings where consultative support is limited.

Staff behavior toward children and adolescents in a residential facility: a self-report questionnaire.

The purpose of the present study was to examine psychometric properties of the Staff Behavior toward Clients questionnaire (SBC), a self-report measure for care staff working with children and adolescents with mild to borderline intellectual disabilities in residential care. Ninetynine care staff completed the SBC and the Strengths and Difficulties Questionnaire (SDQ) for 99 of their clients. Factor analysis revealed four factors (i.e. behavior regulation, client-directed care, teaching and empowerment). Results indicated excellent internal consistency of all factors and ability of the SBC to detect differences in client populations with respect to behavior problems. These data suggest that the SBC could provide a reliable and valid measure of staff behavior toward clients in residential facilities.

Applications of operant learning theory to the management of challenging behavior after traumatic brain injury.

For more than 3 decades, interventions derived from learning theory have been delivered within a neurobehavioral framework to manage challenging behavior after traumatic brain injury with the aim of promoting engagement in the rehabilitation process and ameliorating social handicap. Learning theory provides a conceptual structure that facilitates our ability to understand the relationship between challenging behavior and environmental contingencies, while accommodating the constraints upon learning imposed by impaired cognition. Interventions derived from operant learning theory have most frequently been described in the literature because this method of associational learning provides good evidence for the effectiveness of differential reinforcement methods. This article therefore examines the efficacy of applying operant learning theory to manage challenging behavior after TBI as well as some of the limitations of this approach. Future developments in the application of learning theory are also considered.

Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder.

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations.