Adaptive Behavioral Changes Research Articles

Local and global reward learning in the lateral frontal cortex show differential development during human adolescence.

Reward-guided choice is fundamental for adaptive behaviour and depends on several component processes supported by prefrontal cortex. Here, across three studies, we show that two such component processes, linking reward to specific choices and estimating the global reward state, develop during human adolescence and are linked to the lateral portions of the prefrontal cortex. These processes reflect the assignment of rewards contingently to local choices, or noncontingently, to choices that make up the global reward history. Using matched experimental tasks and analysis platforms, we show the influence of both mechanisms increase during adolescence (study 1) and that lesions to lateral frontal cortex (that included and/or disconnected both orbitofrontal and insula cortex) in human adult patients (study 2) and macaque monkeys (study 3) impair both local and global reward learning. Developmental effects were distinguishable from the influence of a decision bias on choice behaviour, known to depend on medial prefrontal cortex. Differences in local and global assignments of reward to choices across adolescence, in the context of delayed grey matter maturation of the lateral orbitofrontal and anterior insula cortex, may underlie changes in adaptive behaviour.

Climate adaptation and WASH behavior change in the Lake Victoria Basin

AbstractAs climate change disrupts the global hydrological cycle, bringing extremes of flooding and drought, many communities will experience changes in water and sanitation quality and access, requiring adaptive behavior changes. This study set out to map the adaptation patterns – namely, the strategies employed to cope with water, sanitation, and hygiene (WASH)-related impacts of climate change – within the Mabinju community, located along the banks of Lake Victoria in Western Kenya. Qualitative methods were employed, involving 17 semi-structured individual interviews and seven focus groups with village members. Insights derived from direct conversations with village members were deepened through qualitative interviews with an additional 13 WASH sector stakeholders working in the wider Lake Victoria Basin region. Through this study, various WASH-specific community adaptation measures were identified, with both positive and negative impacts on long-term local climate resilience. While many positive coping strategies were found to be spurred by the creative faculties of local residents, capacities for adaptation were found to be restrained by broader forces of poverty and resource access, resulting in the adoption of certain maladaptive coping mechanisms. These findings highlight the need for climate adaptation interventions in the WASH sector to simultaneously build on existing resilience-enhancing measures while addressing the root causes of maladaptation.

Persistence and generalization of adaptive changes in auditory localization behavior following unilateral conductive hearing loss.

Sound localization relies on the neural processing of binaural and monaural spatial cues generated by the physical properties of the head and body. Hearing loss in one ear compromises binaural computations, impairing the ability to localize sounds in the horizontal plane. With appropriate training, adult individuals can adapt to this binaural imbalance and largely recover their localization accuracy. However, it remains unclear how long this learning is retained or whether it generalizes to other stimuli. We trained ferrets to localize broadband noise bursts in quiet conditions and measured their initial head orienting responses and approach-to-target behavior. To evaluate the persistence of auditory spatial learning, we tested the sound localization performance of the animals over repeated periods of monaural earplugging that were interleaved with short or long periods of normal binaural hearing. To explore learning generalization to other stimulus types, we measured the localization accuracy before and after adaptation using different bandwidth stimuli presented against constant or amplitude-modulated background noise. Retention of learning resulted in a smaller initial deficit when the same ear was occluded on subsequent occasions. Each time, the animals' performance recovered with training to near pre-plug levels of localization accuracy. By contrast, switching the earplug to the contralateral ear resulted in less adaptation, indicating that the capacity to learn a new strategy for localizing sound is more limited if the animals have previously adapted to conductive hearing loss in the opposite ear. Moreover, the degree of adaptation to the training stimulus for individual animals was significantly correlated with the extent to which learning extended to untrained octave band target sounds presented in silence and to broadband targets presented in background noise, suggesting that adaptation and generalization go hand in hand. Together, these findings provide further evidence for plasticity in the weighting of monaural and binaural cues during adaptation to unilateral conductive hearing loss, and show that the training-dependent recovery in spatial hearing can generalize to more naturalistic listening conditions, so long as the target sounds provide sufficient spatial information.

부모-아동 상호작용치료가 발달지연 아동의 문제행동과 적응행동에 미치는 효과

Objectives The purpose of this study is to examine the effects of parent-child interaction therapy on problem behaviors and adaptive behaviors in children with developmental delay.
 Methods For this study, parent-child interaction therapy was conducted for a total of 3 pairs of children with developmental delays and their parents at the Child Development Counseling Center located in Gyeonggi-do. For parent-child interaction therapy, a program jointly developed by Sheila Eyberg & Beberly Funderbu (2011) was applied. After that, the child behavior evaluation scale (CBCL) and the adaptive behavior test tool for children (NISE-K⋅ABS) were used to measure the change in problem behavior and adaptive behavior of pre- and post-treatment children.
 Results After parent-child interaction therapy, child behavior problems were significantly reduced and adaptive behaviors were significantly increased. There were clear positive changes in interpersonal relationships and other-person recognition areas, which are subordinate areas of adaptive behaviors.
 Conclusions This study is significant in that it empirically validates that parent-child interaction therapy is effective in reducing problem behaviors and improving adaptive behaviors in children with developmental delay.

Developmental and behavioral groupings can predict changes in adaptive behavior over time in young children with neurodevelopmental disorders

The heterogeneity within, and the overlap between, diagnostic categories for neurodevelopmental disorders (NDDs) remain poorly understood. Developmental trajectories may diverge among children with the same diagnosis, who may also respond very differently to treatment. In a previous study, we used statistical clustering methods in a sample of 194 preschoolers who were referred for NDD assessment. We identified three distinct subgroups based on multiple developmental and behavioral variables. The present study aimed to identify: (1) early developmental markers at the surveillance and screening period that are predictive of subgroup membership at the diagnostic period (i.e., around age 5), (2) associations between subgroups and the evolution of adaptive behavior over the course of two years, and (3) predictors of adaptive behavior change. Subgroup membership was the only significant predictor of adaptive behavior change over time, which suggests that a clustering method based on developmental and behavioral profiles may be useful in treatment planning.

Clinical Application of a Peer Coaching Intervention to Enhance Self-Management for Adolescents and Young Adults With Inflammatory Bowel Disease.

The purpose of this article is to characterize the current evidence base related to peer support interventions for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) and to describe a peer support program to enhance self-management for AYAs with IBD through a case study. There is strong theory and compelling evidence suggesting that AYAs with IBD could benefit from and are interested in receiving peer support to enhance self-management; however, literature on peer support interventions for AYAs with IBD is lacking. This study (a) presents a topical review describing qualitative factors AYAs with IBD would seek in a peer support program as well as existing peer support programs for this population, (b) presents an innovative one-to-one peer support program targeting self-management through a case study, and (c) discusses clinical implications and directions for future research. Peer support offers a promising approach for AYAs with IBD that is feasible and acceptable to patient populations. However, results from the present topical review identified only two studies that examined peer support interventions for AYAs with IBD. The case study demonstrates how a theoretically driven program uses peer support to promote self-management and adaptive behavioral change. The paucity of literature in this area reveals a critical opportunity for future research and clinical programming to improve existing practices by leveraging peer support. We present the application of an innovative mobile-based peer coaching intervention that has the potential to support AYAs with IBD in their self-management.

ADAPTASI MASYARAKAT TERDAMPAK BANJIR DI DAERAH ALIRAN SUNGAI LIMBOTO

The purpose of this study is to analyze the adaptation of flood-affected residents in the Limboto watershed. The research method is a qualitative method that examines phenomena comprehensively with a case study approach. Interactive data analysis using three stages including; data reduction, data presentation, and conclusion drawing. The results showed that during the 2018-2022 period, there were 139 flood events in the Limboto watershed, spread over 50 sub-districts/villages in 10 sub-districts. The impacts of flooding in the Limboto watershed also vary, ranging from material, economic, health, housing losses, to the death toll. This impact has prompted changes in adaptive behavior in affected communities in the Limboto watershed, such as the creation of an early warning system, an evacuation stage, the construction of temporary embankments, new livelihoods, and providing equipment to deal with floods

Children and adolescents with ASD treated with CBD-rich cannabis exhibit significant improvements particularly in social symptoms: an open label study

In recent years there has been growing interest in the potential benefits of CBD-rich cannabis treatment for children with ASD. Several open label studies and one double-blind placebo-controlled study have reported that CBD-rich cannabis is safe and potentially effective in reducing disruptive behaviors and improving social communication. However, previous studies have mostly based their conclusions on parental reports without the use of standardized clinical assessments. Here, we conducted an open label study to examine the efficacy of 6 months of CBD-rich cannabis treatment in children and adolescents with ASD. Longitudinal changes in social communication abilities and restricted and repetitive behaviors (RRB) were quantified using parent report with the Social Responsiveness Scale and clinical assessment with the Autism Diagnostic Observation Schedule (ADOS). We also quantified changes in adaptive behaviors using the Vineland, and cognitive abilities using an age-appropriate Wechsler test. Eighty-two of the 110 recruited participants completed the 6-month treatment protocol. While some participants did not exhibit any improvement in symptoms, there were overall significant improvements in social communication abilities as quantified by the ADOS, SRS, and Vineland with larger improvements in participants who had more severe initial symptoms. Significant improvements in RRB were noted only with parent-reported SRS scores and there were no significant changes in cognitive scores. These findings suggest that treatment with CBD-rich cannabis can yield improvements, particularly in social communication abilities, which were visible even when using standardized clinical assessments. Additional double-blind placebo-controlled studies utilizing standardized assessments are highly warranted for substantiating these findings.

Increasing precision in the measurement of change in pediatric neurodegenerative disease.

Due to the surge in new brain-directed treatments, metrics to detect the alteration in developmental trajectories in cognition and adaptive behavior have become increasingly important. We propose Growth Scale Values (GSVs) as a solution to monitoring children with severe neurologic/neurodegenerative conditions. This report stems from a panel of experts presenting at the Gorlin symposium (WORLD Symposium) and a subsequent open Webinar sponsored by the National MPS Society. Because norm-referenced scores (Standard Scores or Intelligence Quotient, i.e., IQ) do not yield information about gain, stability, or loss of skills, they are not suitable for natural history studies or clinical trials. Age-equivalent (AE) scores have been the standard metric used in natural history studies. While AEs are familiar and interpretable to clinicians and parents, they are imprecise due to lack of standard deviations, standard errors of measurement, and equal intervals between scores. Raw scores also have unequal intervals and are not comparable between ages or ability levels. The GSV, a nonlinear transformation of raw scores using item calibration to make an interval scale score, can be used for accurate measures of within-person change. GSVs have been identified as a useful metric for longitudinal measurement of other conditions involving neurodiversity. These growth scores circumvent inaccurate AEs in infants, are not limited by age and can be used for impaired patients who are chronologically above the normative age range. GSVs have interval properties (a given difference between GSV values represents the same difference in ability at all score levels) and each GSV value has a known standard error of measurement (SEM). GSVs are recommended to measure change in cognitive and adaptive behavior in natural history studies and in clinical trials for children with neurologic disease.

Intensive behavioural interventions based on applied behaviour analysis (ABA) for young children with autism: A cost-effectiveness analysis.

BackgroundThe economic and social costs of autism are significant. This study evaluates the cost-effectiveness of early intensive Applied Behaviour Analysis (ABA)-based interventions for autistic pre-school children in the UK.MethodsA de novo economic analysis was developed in Microsoft Excel comparing early intensive ABA-based interventions compared with treatment as usual (TAU). The analysis used 15.5-year time horizon, with costs and benefits discounted a 3.5%. The model structure was based on cohort structure to capture changes in adaptive behaviour and cognitive ability over time. The analysis was informed by an individual patient data (IPD) meta-analysis of available evidence.ResultsAdopting a public sector perspective, early intensive ABA-based therapies were associated with greater incremental costs and greater benefits. When pessimistic assumptions were made regarding the long-term effects of treatment incremental costs were £46,103 and incremental quality-adjusted life years (QALYs) were 0.24, resulting in an incremental cost-effectiveness ratio (ICER) of £189,122 per quality-adjusted life year (QALY). When optimistic assumptions were made about long-term effects, incremental costs were £39,233 with incremental benefits of 0.84 QALYs. The resulting ICER was £46,768 per QALY. Scenario analyses emphasised the importance of assumptions made regarding adult outcomes and type of school attended, both of which significantly affect the results of the analysis.ConclusionsThe results of this economic analysis suggest that early intensive ABA-based interventions are unlikely to represent value for money, based on a £20,000 to £30,000 per QALY threshold typically adopted to inform UK healthcare funding decisions. However, important gaps in the available evidence, limit the strength of the conclusions that can be drawn from the presented analysis. Further research, focusing on the trajectory of autistic children following intervention is likely to be highly beneficial to resolving some of these uncertainties.

Motivating Machines: The Potential of Modeling Motivation as MoA for Behavior Change Systems

The pathway through which behavior change techniques have an effect on the behavior of an individual is referred to as the Mechanism of Action (MoA). Digitally enabled behavior change interventions could potentially benefit from explicitly modelling the MoA to achieve more effective, adaptive, and personalized interventions. For example, if ‘motivation’ is proposed as the targeted construct in any behavior change intervention, how can a model of this construct be used to act as a mechanism of action, mediating the intervention effect using various behavior change techniques? This article discusses a computational model for motivation based on the neural reward pathway with the aim to make it act as a mediator between behavior change techniques and target behavior. This model’s formal description and parametrization are described from a neurocomputational sciences prospect and elaborated with the help of a sub-question, i.e., what parameters/processes of the model are crucial for the generation and maintenance of motivation. An intervention scenario is simulated to show how an explicit model of ‘motivation’ and its parameters can be used to achieve personalization and adaptivity. A computational representation of motivation as a mechanism of action may also further advance the design, evaluation, and effectiveness of personalized and adaptive digital behavior change interventions.

Neurobiological Correlates of Change in Adaptive Behavior in Autism

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition that is associated with significant difficulties in adaptive behavior and variation in clinical outcomes across the life span. Some individuals with ASD improve, whereas others may not change significantly, or regress. Hence, the development of "personalized medicine" approaches is essential. However, this requires an understanding of the biological processes underpinning differences in clinical outcome, at both the individual and subgroup levels, across the lifespan. The authors conducted a longitudinal follow-up study of 483 individuals (204 with ASD and 279 neurotypical individuals, ages 6-30 years), with assessment time points separated by ∼12-24 months. Data collected included behavioral data (Vineland Adaptive Behavior Scale-II), neuroanatomical data (structural MRI), and genetic data (DNA). Individuals with ASD were grouped into clinically meaningful "increasers," "no-changers," and "decreasers" in adaptive behavior. First, the authors compared neuroanatomy between outcome groups. Next, they examined whether deviations from the neurotypical neuroanatomical profile were associated with outcome at the individual level. Finally, they explored the observed neuroanatomical differences' potential genetic underpinnings. Outcome groups differed in neuroanatomical features (cortical volume and thickness, surface area), including in "social brain" regions previously implicated in ASD. Also, deviations of neuroanatomical features from the neurotypical profile predicted outcome at the individual level. Moreover, neuroanatomical differences were associated with genetic processes relevant to neuroanatomical phenotypes (e.g., synaptic development). This study demonstrates, for the first time, that variation in clinical (adaptive) outcome is associated with both group- and individual-level variation in anatomy of brain regions enriched for genes relevant to ASD. This may facilitate the move toward better targeted/precision medicine approaches.

Idea paper: Controlling trait adaptation to decrease population densities for conservation and management

AbstractEcologists and evolutionary biologists have revealed that adaptive microevolution (i.e., allele frequency changes through time) and behavioral changes occur rapidly enough to affect contemporary ecological dynamics, and we can consider rapid adaptation for better conservation and management of wild populations. However, previous studies tended to focus on adaptation that increases population densities (e.g., evolutionary rescue), and did not pay attention to adaptation that decreases population densities (e.g., evolutionary suicide). Here, we demonstrate that controlling trait adaptation may be potentially important for decreasing population densities. One possibility is introducing “selfish” genotypes to populations. If the genotypes increase their reproductive success at the expense of population growth (e.g., cheaters in subsocial ants or coercive males in damselflies), we can decrease population densities (intraspecific adaptation load). The other possible option is diverting trait values of animals from the value that maximizes population growth (ecological trap). For example, we may be able to change behavior of a deer population by hunting so that they will not approach the best habitat with ample resources (landscape of fear). Then, we can consider the optimal allocation of our effort to directly decrease their population densities and control their trait values. However, we should carefully conduct controlling trait adaptation because it may result in unintended outcomes through modified genetic compositions and behaviors, such as increasing genetic variation of the focal population that enhances adaptation to changing environments by introducing selfish genotypes or a transient increase of population densities by modified behaviors.

The impact of punishment on cognitive control in a clinical population characterized by heightened punishment sensitivity.

Punishments can help inform us to make adaptive changes in behavior. However, previous research suggested that only low punishment-sensitive individuals "learn" from punishment, whereas high punishment-sensitive individuals do not. Here we used a flanker interference task with performance-contingent punishment signals to test the hypothesis that a clinical group characterized by heightened punishment sensitivity (i.e., patients with anorexia nervosa [AN]) would fail to adapt to conflict following punishment. To distinguish between state and trait factors, we tested for between-group differences in separate cohorts of acutely underweight patients (acAN; n = 40) and weight-recovered former patients (recAN; n = 25) relative to age-matched healthy controls (n = 48). The acAN patients showed an abnormally reversed congruency-sequence effect in error rates following punishment, despite generally superior accuracy, suggesting that punishment distracted acAN patients and interfered with interference control. The influence of punishment was more subtle in recAN and did not reach statistical significance, but both reaction time and error rate data hinted that elevated sensitivity to punishment negatively affects cognitive control even after long-term weight normalization. Together, these findings emphasize that punishment sensitivity may be a clinically relevant trait marker in AN and provide novel experimental evidence that punishment may have a detrimental impact on adaptive behavior in the disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavioral Changes, Adaptation, and Supports among Indonesian Female Sex Workers Facing Dual Risk of COVID-19 and HIV in a Pandemic.

The objective of this study is to explore the impacts of COVID-19 and changes taking place among the Indonesian female sex worker (FSW) community during the COVID-19 pandemic and the predictors of these changes. We conducted a cross-sectional online survey and selected the participants using a purposive snowball sampling technique. Incentives were provided to participants in the form of a 5 USD e-wallet balance. Variables of interest included adaptation to online sex work, adherence to COVID-19 prevention measures during sex work, number of clients, income reduction, social support, condom access, and condom use frequency. Sociodemographic data and COVID-19 fear index values were also collected. Final analysis included 951 FSWs, of whom 36.4% of had adapted to online sex work and 48.6% had practiced COVID-19 prevention measures. Major reductions in client frequency and income were reported by 67.8% and 71.1% of respondents, respectively. However, only 36.3% of FSWs reported they had ever received any form of social support from any parties, public or private. Meanwhile, 16.7% encountered difficulties in accessing condoms and 12.5% reported less frequent condom use during the pandemic. Easy access to condoms was the main factor influencing the frequency of condom use. As expected, staying in employment protected FSWs from major income loss, while education and younger age predicted adaptive behavioral changes, such as taking up online sex work. The COVID-19 pandemic has disrupted access to socioeconomic support systems and HIV prevention services among FSWs and has further exposed them to the dual jeopardy of HIV and COVID-19 infections.

Adaptive Changes in Sexual Behavior in the High-Risk Population in Response to Human Monkeypox Transmission in Canada Can Control the Outbreak: Insights from a Two-Group, Two-Route Epidemic Model

Adaptive Changes in Sexual Behavior in the High-Risk Population in Response to Human Monkeypox Transmission in Canada Can Control the Outbreak: Insights from a Two-Group, Two-Route Epidemic Model

Additive Manufacturing Interventions during the COVID-19 Pandemic: South Africa

Additive manufacturing (AM), also known as 3D printing, is considered a renaissance of the manufacturing industry. Its unique capability of manufacturing 3D objects with intricate geometrical configurations has been used to produce hospital equipment and personal protective equipment (PPE) in an attempt to curb the spread of the COVID-19 pandemic in South Africa. The technology has been used by different research units to produce ventilators, respirator face masks, oscillating respiratory devices, oxygen connectors, oxygen splitters, non-invasive ventilation helmets, reusable clinician PPE, visor frames for face shields, etc. Despite the efforts of the AM community in South Africa, COVID-19 infections have continued to increase in the country. It came to light that technological interventions (including AM) alone cannot prevent the spread of the virus without the corresponding adaptive behavioural changes, such as adhering to COVID-19 prevention protocols (washing of hands, social distancing, etc.). It could be postulated that the spread of COVID-19 can only be prevented by inter-marrying the technological interventions (AM) with adaptive behavioural changes.

Analysis of cognitive ability and adaptive behavior assessment tools used in an observational study of patients with mucopolysaccharidosis II

BackgroundMucopolysaccharidosis II (MPS II) is a rare lysosomal storage disease characterized by cognitive impairment in most patients. This post hoc analysis evaluated changes in cognitive function, adaptive behavior and functional outcomes in patients with neuronopathic MPS II over time. Fifty-five children with MPS II were enrolled in a 24-month observational study (NCT01822184). The Differential Ability Scales, second edition (DAS-II; early years battery for ages 2 years 6 months to 6 years 11 months, school age battery for ages 7 years to 17 years 11 months), Vineland Adaptive Behavior Scales, second edition (VABS-II) and the Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) were performed at baseline and 3-month intervals over 2 years. A subgroup of 38 children with a DAS-II General Conceptual Ability (GCA) score of 55–85 (below average–very low abilities) at any time during the study were included in this analysis.ResultsMean (standard deviation [SD]) early years DAS-II GCA score decreased from 73.4 (15.7, n = 22) at baseline to 62.7 (34.9, n = 6) at month 24. For the six patients with early years GCA assessments at baseline and month 24, mean (SD) GCA scores decreased from 72.3 (21.3) at baseline to 62.7 (34.9) at month 24. School age GCA scores were stable over 2 years: mean (SD) 72.4 (11.8, n = 10) at baseline; 74.3 (12.3, n = 8) at month 24. Mean (SD) VABS-II Adaptive Behavior Composite (ABC) scores were stable throughout the study (baseline, 81.8 [11.8, n = 36]; month 24, 81.0 [10.2, n = 13]). Some associations between items and domains of HS-FOCUS (p < 0.05) and DAS-II GCA and VABS-II ABC scores were shown, but there was no clear pattern of changes in HS-FOCUS over 2 years.ConclusionsThe DAS-II measured changes in cognitive function over 2 years in younger patients with MPS II, whereas cognitive function in older patients remained stable. Further research is required to confirm the content validity of the DAS-II in different patient populations with MPS II. The VABS-II and HS-FOCUS were not sensitive tools for measuring behavioral and functional changes over 2 years. These findings may inform selection of appropriate cognitive and behavioral assessment tools for future studies.

Individual differences in COVID-19 mitigation behaviors: The roles of age, gender, psychological state, and financial status.

The present study examined individual characteristics potentially associated with changes in mitigation behaviors (social distancing and hygiene) recommended by the Centers for Disease Control and Prevention. Analysis of online survey responses from 361 adults, ages 20–78, with US IP addresses, identified significant correlates of adaptive behavioral changes, with implications for preventive strategies and mental health needs. The extent to which individuals changed their mitigation behaviors was unrelated to self-rated health or concern regarding the personal effects of COVID-19 but was related to concern regarding the effects of the pandemic on others. Thus, mitigation behaviors do not appear to be primarily motivated by self-protection. Importantly, adaptive changes in mitigation behaviors increased with age. However, these changes, particularly those related to the frequency of close proximity encounters, appear to be due to age-related decreases in anxiety and depression. Taken together, the present results argue against over-reliance on ‘fear appeals’ in public health messages as they may increase anxiety and depression. Instead, the present findings argue for more appeals to people’s concern for others to motivate mitigation as well as indicating an immediate need to address individual mental health concerns for the sake of society as a whole.

Atopic Dermatitis: Preventing and Managing the Itch That Rashes, and a Case for the Multi-Theory Model (MTM) for Health Behavior Change for Educational Interventions

Atopic dermatitis (AD) is a multifactorial disease affected by a host of genetic, environmental, socioeconomic and demographic influences, that induce the atopic immune response in predisposed individuals. Despite treatment with topical corticosteroids to reduce skin inflammation, emollients to improve the skin barrier, and avoidance of inflammatory triggers, many patients report progressive symptoms. Management strategies are developed as modifiable environmental influences are identified. Managing atopic dermatitis requires adaptive changes in health behavior involving the patient and often the caregiver. Multi-theory models (MTM) have not yet been used in AD interventions but may prove beneficial as they use behavior concepts to predict both initiation and sustenance in education health interventions. A comprehensive approach fosters such changes by using psychological and educational strategies as adjuncts to conventional therapy. This article reviews the challenges in managing AD and the potential impact of behavioral theories. This is designed to strengthen the argument for using an MTM model in future studies of AD.