“How can I apply this information in my clinical practice?” Clinical measures of respiratory rate, heart rate, and chest wall excursion do not require expensive equipment or training. An inexpensive pulse oximeter provides therapists with clinically important oxygen saturation and heart rate measures. The number of hospitalizations for respiratory illnesses may also serve as a marker of respiratory health. Therapists can use positioning to promote expansion in areas of limited chest wall mobility, such as the lateral or posterior aspects. Chest physical therapy techniques are valuable augments to positioning. Adaptive physical activity may also improve cardiorespiratory function. Therapists can apply this information to persons with multiple disabilities in settings such as home care, group homes, schools, and skilled nursing facilities. “What should I be mindful about in applying this information?” Therapists should be mindful that the rationale for positioning persons with cerebral palsy with severe mobility limitations and scoliosis should include not only respiratory function but also function of other internal organ systems, skin integrity, soft tissue extensibility, bone density, and comfort. Position changes may also accommodate functional needs, such as using vision and performing cognitive tasks. Using a variety of positions is beneficial. Prone positioning may promote improved respiratory function. Supported standing is another option. Upright positioning may promote social interaction, alertness, vocalization, and use of vision. Although sitting may improve respiratory function, prolonged sitting may compromise muscle length and skin integrity. In assessing vital signs, laying hands on the patient may change parameters such as breathing pattern or depth. The effect of a thoracolumbosacral orthosis must also be considered. The authors noted that these individuals' primary breathing pattern was diaphragmatic. Measuring upper chest, mid-chest, and abdominal expansion may demonstrate the full effects of position changes on chest wall excursion. Therapists should also be mindful of signs of distress, such as changes in facial expression, increased muscle tone, flushing, or pallor. Blood pressure may also need to be monitored. The clinical bottom line for this article may be that persons with cerebral palsy with limited mobility and respiratory compromise should be transitioned into a variety of positions throughout the day. The respiratory status of each individual requires ongoing monitoring to determine optimal positioning. Margaret Barry Michaels, PT, PhD, PCS Slippery Rock University, Slippery Rock, Pennsylvania Theresa M. Crytzer, DPT, ATP Western Pennsylvania School for the Blind University of Pittsburgh, Pittsburgh, Pennsylvania

This article presents a critical analysis of empirical studies assessing literacy and other domains of academic achievement among children with cochlear implants. A variety of recent studies have demonstrated benefits to hearing, language, and speech from implants, leading to assumptions that early implantation and longer periods of implant should be associated with higher reading and academic achievement. This review, however, reveals that although there are clear benefits of cochlear implantation to achievement in young deaf children, empirical results have been somewhat variable. Examination of the literature with regard to reading achievement suggests that the lack of consistent findings might be the result of frequent failures to control potentially confounding variables such as age of implantation, language skills prior to implantation, reading ability prior to implantation, and consistency of implant use. Studies of academic achievement beyond reading are relatively rare, and the extent to which performance in such domains is mediated by reading abilities or directly influenced by hearing, language, and speech remains unclear. Considerations of methodological shortcomings in existing research as well as theoretical and practical questions yet to be addressed provide direction for future research.

The purpose of this report is to describe a community-based fitness program developed and implemented for children with disabilities. Several outcomes are reported for one of the participants, J, an 11-year-old girl with hypotonia and mild mental retardation, to illustrate the strengths and limitations of this program and to help guide clinicians and researchers in developing and critically assessing the effectiveness of similar programs. The fitness program, called "Off the Couch," (OTC) was provided in six-week sessions for one hour per week. Outcomes examined included the energy expenditure index (EEI), rating of perceived exertion (RPE), maximum running velocity, and the overall daily activity level of the child and the number of exercise sessions that the child participated in over a two-week time period. J demonstrated a reduction in EEI and a slight improvement in maximum running velocity. Activity level remained at a relatively high level. The program is discussed with respect to feasibility in a clinical setting, suggestions for similar programs and areas for related research. J's outcomes are discussed in terms of their functional relevance.

Considerable attention has focused on the role of family dysfunction in the development of adolescent substance abuse, particularly in families where a parent has a history of alcohol and drug abuse. This study examined parental reports of dissatisfaction with 41 boys (ages 10-12) of fathers with a history of substance abuse (SA+) and 68 boys of fathers without such a history (SA-). Higher dissatisfaction ratings by both mothers and fathers were found in the SASA+ group in contrast to the SA- group. Both child externalizing behavior problems and parental personality characteristics were correlated with dissatisfaction. Stepwise regression analysis revealed that father's negative affectivity, followed by externalizing symptoms in the boys, were most predictive of dissatisfaction in both mothers and fathers. The implications of these results for an understanding of the adverse family context of substance abuse are discussed.

Four decades of increased empiricism in the field of clinical psychology have served to yield several confident responses to Paul’s “ultimate” question: “What treatment, by whom, is most effective for this individual with that specific problem under which set of circumstances?” (1967, p. 111). Paul’s call for specification of the conditions under which an intervention will be effective is consistent with the notion of a “prescriptive” approach to the treatment of psychopathology (i.e., the prescription of a highly specified, thoroughly evaluated treatment regimen in order to ameliorate a highly specified, thoroughly assessed complaint). Application of prescriptive interventions to psychological problems is not entirely novel. Indeed, this has been the approach followed by the psychopharmacological field for some time (albeit with somewhat limited success, the causes of which will be discussed below). Reasons for psychologists’ delay in deriving and applying prescriptive psychological treatments to psychopathology become apparent through examination of early 20th century trends in theory and conceptualization.

We evaluated the effectiveness of a training package used to teach student-selected community-referenced leisure skill clusters — ordering a pizza-to-go and renting a video from a local vendor — to two adolescents with multiple disabilities. The adolescents were taught the leisure skills (e.g., ordering the pizza) as well as related behaviors necessary to perform those leisure skills (e.g., using a phone, interacting with the delivery person, cutting and serving pizza, cleaning up). The students were taught functional skill clusters, problem-solving skills, and assistance-seeking skills. Training consisted of didactic instruction, feedback, a least intrusive prompting procedure for incorrect responses, and verbal praise and natural consequences for correct responses. Simulation training was conducted at school and in vivotraining was conducted in the local community. A multiple baseline design demonstrated the controlling effects of treatment. Also, follow-up probes conducted up to five months after treatment showed these students maintained treatment gains. Applied issues related to the efficiency of the training package, general and specific skills training, and factors influencing skill maintenance are discussed.

Previous research on attention-seeking problem behavior has focused on individuals who misbehaved under general conditions of low adult attention. In general, no detailed analyses were conducted to determine whether different situations involving low levels of adult attention (such as familiar vs. unfamiliar adults, setting events, or the presence or absence of peers) exacerbated or attenuated problem behavior. The current case study demonstrates that, for one adolescent, all situations involving low levels of adult attention were not equally discriminative for problem behavior. Two functional analyses concerning different situations involving low levels of adult attention were conducted. The first analysis consisted of systematically manipulating antecedent and consequence conditions related to adult attention and task demands. This analysis indicated that low levels of adult attention evoked problem behavior. The second analysis involved two different conditions presenting low levels of adult attention. In one, the adult spoke to another child; in the second, the adult spoke to another adult. This second analysis revealed that, when the adult spoke to another adult, problem behavior resulted. However, when the adult spoke to another child, problem behavior did not occur. On the basis of these functional analyses, a positive intervention was designed to reduce problem behavior. Theoretical implications related to functional analysis are discussed, and applied issues concerning functionally based treatment selection are explored.

We investigated psychosocial correlates of loneliness using self- and caretaker-reports in 6–12 year old nonreferred and psychiatrically hospitalized children. In Phase 1, 109 nonreferred children completed self-report measures of internalizing problems, mothers completed the Child Behavior Checklist (CBCL), and teachers completed the CBCL-Teacher's Report Form. In Phase 2, a similar assessment battery was completed for 109 psychiatrically hospitalized children. Results indicated a moderate to strong relationship between loneliness and self-reported depression, hopelessness, low self-esteem, and anxiety. Children reporting high and low levels of loneliness were not differentiated by parent or teacher reports. Lonely children had lower IQs than their non-lonely peers.