Behavior Management Procedures Research Articles

Dental implications of childhood obesity and prevention and management methods in dental office

Childhood obesity is a common chronic disease in childhood, and its prevalence and socioeconomic costs have increased worldwide over the past 40 years. The World Health Organization has designated obesity as a global epidemic, emphasizing the need for its treatment and management. The impacts of childhood obesity on dentistry include a higher risk of dental caries, advanced dental development, as well as psychological changes (anxiety, depression, attention deficit hyperactiv-ity disorder) and physical changes (increased complications, changes in drug metabolism) that should be considered when implementing preventive strategies, orthodontic treatment, behavior management and sedative procedures. Dentists should regularly check child’s body mass index and diet for every child visiting dental office. Parental obesity, consumption of sugar-sweetened beverages, poor dietary habits, and lack of exercise can be a risk factors for obesity in normal/overweight child. Diet counseling should be provided to high-risk children and their parents. Preventing childhood obesity is crucial, and the key point in treating childhood obesity is behavior modification therapy, which focuses on regulating daily eatinghabits and physical activity. Dentists should recognize the seriousness of childhood obesity and participate in the prevention and management of the obesity epidemic, thus enhancing oral and systemic health

Management of Post-Traumatic Dental Care Anxiety in Pediatric Dental Practice-A Clinical Study.

Background: It is important to avoid giving children traumatic dental experiences that induce post-traumatic dental care anxiety (PTDA) in clinical dental practices. The aim of this study was to evaluate whether non-pharmacological behavior management procedures can effectively reduce the use of pharmacological behavior management in children who have PTDA and are referred for regular dental treatments under general anesthesia (GA) and sedation. Methods: This clinical study consisted of two groups. The treatment group involved 20 healthy children aged 4–14 with PTDA and also those referred by other institutions for dental treatment with/without GA. The control group was sampled retrospectively from the patient records and involved 20 healthy uncooperative children aged 4–14 with PTDA who had been treated under GA. Results: The number of multiple appointments was significantly higher in the treatment group than in the control group. Only 25% of children in the treatment group underwent GA and the rest (75%) were managed with non-pharmacological management techniques. Nine (60%) children who were treated with minimally invasive techniques did not require GA. Conclusions: It is important to treat children as much as possible without causing PTDA by using appropriate behavior management techniques. This study emphasizes the usefulness of thoroughly employing non-pharmacological behavior management methods before directing a child with PTDA for dental treatment under pharmacological behavior management, which can prevent the over-utilization of sedation and GA.

Training Direct Service Personnel in Functional Communication Training with Adults with Disabilities

Adults with intellectual and developmental disabilities (IDD) may engage in challenging behavior. These behaviors present challenges to support staff who often lack training in effective behavior management procedures. Behavioral skills training (BST) is an empirically supported method of staff training and has been used to teach support staff a number of intervention skills. The purpose of this study was to extend the literature on BST and to examine the effects of BST on staff implementation of functional communication training (FCT) for three adults with IDD using a non-concurrent multiple baseline design. Results indicated that with BST, staff fidelity increased over baseline levels. With the addition of individualized coaching, staff implementation reached mastery criteria. Improvements in staff implementation fidelity corresponded with decreases in participant challenging behavior and increases in appropriate communication. Findings suggest that BST with coaching may be an effective method to train staff to implement FCT with adults.

Preliminary Findings of Culturally Responsive Consultation with Educators.

Behavior analysts are increasingly called to serve culturally and linguistically diverse populations. The culture of a population can provide context in which to identify behaviors likely to be reinforced by the client's social environment, stimuli established as reinforcers for client behavior, and behavioral repertoires shaped by the client's social environment. One of the largest and fastest growing minority groups in the United States is the Latinx population. This article offers preliminary evidence of incorporating cultural adaptations into the context of behavioral consultation for the Latinx population. Cultural adaptation of behavioral consultation can lead to improved outcomes for educators. In this study, 5 educators received behavioral consultation consisting of behavioral skills training to implement culturally responsive class-wide behavior management procedures. All 5 educators improved their treatment fidelity of the culturally responsive behavior management practices. Implications for practitioners and future research are discussed.

An Application of the Group-Oriented Concurrent-Chains Arrangement.

Group contingencies are a set of behavior management procedures used to improve the behavior of several students simultaneously. Despite evidence supporting the effectiveness of each group contingency in managing academic and challenging behaviors, the decision to select one group contingency over another may be difficult for teachers, especially if similar efficacy is found. In this study, we compared the effectiveness of three group contingencies on disruptive behavior with 13 typically developing eighth-grade students. Results showed that all three group contingencies reduced levels of disruptive behavior from baseline levels. We then assessed the students' individual preferences for the group contingencies using a group-oriented concurrent-chains procedure. Most students showed preference for one of the group contingencies, and most preferred the independent group contingency. These results demonstrated that the group-oriented concurrent-chains procedure was an effective and efficient method of identifying individual preferences for behavior-change procedures in a classroom setting.

Influences of Teacher Professional Development on Student Outcomes & Efficacy

Teacher professional development has taken place in isolation and has been dependent upon input from outside “experts” (Sandholtz, A companion of direct and indirect professional development activities. Professional development for teachers is the range of formal and informal processes and activities that teachers engage in both inside and outside of the school, in order to improve their teaching knowledge and skills. As an alternative, collaborative action research actively involves teachers in professional reflection, validates educators as producers of knowledge, and recognizes their role in professional development and decision making. The value of teacher research is well documented (Cochran–Smith & Lytle, Inside outside: teacher research and knowledge, Teachers College Press, New York, 1993) but unless deliberate attempts to share findings are established, the products of teacher research often remain within individual classrooms. Strategies to develop collaborative research capabilities are needed. The ultimate goal of teacher professional development is improving student learning outcomes. Research indicates that teachers have control over many factors that influence motivation, achievement and behavior of their students. Therefore, professional development focusing on effective classroom management will enhance a teacher's skills and performance in the classroom. Skills such as effective classroom management are vital to teaching and require common sense, consistency, a sense of fairness and courage. The skills also require that teachers understand the psychological and developmental levels of each student. The ability of teachers to organize classrooms and manage the behavior of their students is critical for achieving positive educational outcomes. Although sound behavior management does not guarantee effective instruction, it establishes the environmental context that makes good instruction possible. Reciprocally highly effective instruction reduces, but does not eliminate, classroom behavior problems. Effective classroom management competencies also significantly influence the persistence of new teachers in the classroom. Effective classroom management requires a comprehensive approach that should include structuring the school and classroom environment, actively supervising student engagement, implementing classroom rules, enacting procedures that encourage appropriate behavior, using behavior reduction strategies and collecting and using data to monitor student behavior and modifying classroom management procedures. Therefore in teacher preparation programs greater emphasis needs to be placed on preparing teachers to be competent and efficient at managing today's classrooms with their diverse range of learners. This approach means not only giving pre-service teachers the intellectual understanding of the issues involved but also providing them supervised experience related to components of classroom management. The purpose of this paper is to provide research and recommendations related to professional development of teachers, specifically addressing the area of classroom management to improve learning outcomes

A Flow Chart of Behavior Management Strategies for Families of Children with Co-Occurring Attention-Deficit Hyperactivity Disorder and Conduct Problem Behavior.

Behavioral parent training is an evidence-based treatment for problem behavior described as attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. However, adherence to treatment fidelity and parent performance of the management skills remains an obstacle to optimum outcome. One variable that may limit the effectiveness of the parent training is that demanding behavior management procedures can be deceptively complicated and difficult to perform. Based on outcome research for families of children with co-occurring ADHD and conduct problem behavior, an example of a visual behavior management flow chart is presented. The flow chart may be used to help teach specific behavior management skills to parents. The flow chart depicts a chain of behavior management strategies taught with explanation, modeling, and role-play with parents. The chained steps in the flow chart are elements common to well-known evidence-based behavior management strategies, and perhaps, this depiction well serve as a setting event for other behavior analysts to create flow charts for their own parent training, Details of the flow chart steps, as well as examples of specific applications and program modifications conclude.

Effectiveness of music distraction in the management of anxious pediatric dental patients

Management of Anxious Children in dental office still remains a challenge in day to day pediatric dental practice. The effect of different behavior management procedures in managing anxious children is well documented, for example distraction. This study is an attempt to evaluate the effect of music (audio) distraction in reducing the anxiety using Venham's picture test.

Assessment of Behavior Management and Behavioral Interventions in State Child Welfare Facilities

Summary Official state program reviews of 204 substitute care facilities were assessed for the types of behavior management and behavioral interventions used and the extent to which agency practices were consistent with learning theory principles. Data were also collected on the type and number of professional staff available to implement and oversee these procedures, Results showed that a sizable portion of the agencies used restrictive procedures (e.g. “timeout) for response reduction purposes, but without incorporating positive reinforcement programs (e.g., token or point systems, contingent privileges) that would make the application of these procedures humane and therapeutically effective. Program reviews also indicated that relatively small numbers of professionally trained staff were available on‐site to supervise the use of behavior management procedures and behavioral interventions.

Use of Stimulus Fading and Functional Assessment to Treat Pill Refusal With an 8-Year-Old Boy Diagnosed With ADHD

Pharmacological treatments improve functioning for many of the core problems characteristic of attention deficit/hyperactivity disorder (ADHD). Pharmacological treatment is also useful when delivered in combination with behavior management procedures. However, many children find swallowing pills and capsules difficult, and many refuse treatment outright. There are limited resources available to parents confronted with their children's pill refusal behaviors, especially when these difficulties are not because of skills- or anxiety-related problems. This study describes the use of stimulus fading and functional assessment to eliminate pill refusal with an 8-year-old boy diagnosed with ADHD. The study is a replication and extension of procedures described by Anderson, Ruggiero, and Adams to facilitate pill swallowing for a child diagnosed with HIV. Completely independent pill swallowing was achieved after 12 sessions of stimulus fading supplemented by a functional behavioral assessment. Functional assessment suggested that pill refusal behavior was related to positive (attention) and negative (avoidance) reinforcement.

Stimulus generalization of parenting skills during parent-child interaction therapy.

Behavioral parent training is a common approach to addressing externalizing behavior, which is among the most frequent and costly reasons for children's referral to mental health settings (Kazdin, 1997). Parent training focuses on promoting positive interactions and reducing misbehavior by teaching parents to rearrange the social contingencies for their children's behavior. Systematic research beginning several decades ago showed the promise of this approach (e.g., Budd, Green, & Baer, 1976; Eyberg & Johnson, 1974; Forehand & King, 1977; O'Dell, 1974; Patterson & Reid, 1973; Wahler, Winkle, Peterson, & Morrison, 1965). Reviews (Eyberg, Nelson, & Boggs, 2008) and meta-analyses (Maughan, Christiansen, Jenson, Olympia, & Clark, 2005; Serketich & Dumas, 1996) of several contemporary behavioral parent training models indicate that using parents as therapists is efficacious in treatment of disruptive child behavior. Although 95% of parents report beneficial changes following parent training (Atkeson & Forehand, 1978), the strongest evidence of treatment effects comes from independent observations of parent-child interactions. The meta-analysis by Maughan and colleagues (2005) found that parent-report data indicate more positive outcomes than data collected through independent observers. Maughan et al. speculated this discrepancy may be due to an expectation bias on the part of parents. Patterson and Forgatch (1995) found that changes in parents' interactions with their children, as independently observed after parent training, were better predictors of children's future adjustment than parent or teacher reports. These findings suggest that behavioral parent training is an effective intervention; however, its effects may not be as robust as parent reports would lead us to believe. The current research focuses on one model, Parent-Child Interaction Therapy (PCIT), with strong empirical support in the treatment of 2- to 7-year-old children (Gallagher, 2003; Thomas & Zimmer-Gembeck, 2007). PCIT is a manualized, individual intervention, which draws from attachment, social learning, and developmental theories (Brinkmeyer & Eyberg, 2003; Eyberg & Robinson, 1982). Treatment proceeds in two phases: Child-Directed Interaction (CDI), in which parents learn to provide positive attention while following their child's lead in play, and Parent-Directed Interaction (PDI), in which parents use positively-stated commands and behavior management strategies to enhance compliance. As the parent and child play, the therapist provides immediate feedback and support, typically via a bug-in-the-ear device from behind a one-way observation mirror, to refine the parent's use of target skills. The transition from CDI to PDI and from PDI to termination is dictated by parental skill acquisition and child behavior change, as measured by a set of standardized assessment tools. Studies have demonstrated PCIT's effectiveness both immediately following treatment and at follow-up (e.g., Boggs et al., 2004; Nixon, Sweeney, Erickson, & Touyz, 2004; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998). The extension of behavior changes from the therapy setting to new situations and circumstances is a universal goal of clinical intervention. Conceptually, the transfer of a response to situations beyond those in which training occurs exemplifies stimulus generalization, often referred to as transfer of training (Kazdin, 2001). Presumably, the positive effects of parent training accrue from parents' transfer or generalization of skills (e.g., positive attention, limit setting, consistent use of behavior management procedures) outside the therapy setting. In 1977, Forehand and Atkeson reviewed research on the generality of treatment effects with parents as therapists across time, settings, behaviors, and siblings. They found that, the more rigorous the method of assessment, the less positive the results had been. …

Assessment of behavior management and behavioral interventions in state child welfare facilities

Summary Official state program reviews of 204 substitute care facilities were assessed for the types of behavior management and behavioral interventions used and the extent to which agency practices were consistent with learning theory principles. Data were also collected on the type and number of professional staff available to implement and oversee these procedures, Results showed that a sizable portion of the agencies used restrictive procedures (e.g. “timeout") for response reduction purposes, but without incorporating positive reinforcement programs (e.g., token or point systems, contingent privileges) that would make the application of these procedures humane and therapeutically effective. Program reviews also indicated that relatively small numbers of professionally trained staff were available on‐site to supervise the use of behavior management procedures and behavioral interventions.

Examining the effects of teacher and self-evaluation of disruptive behavior via school-home notes for two young children in kindergarten.

Abstract This study replicates and extends previous research in the area of managing the disruptive classroom behavior of young children. The effectiveness of teacher and self-evaluation through school-home notes was explored. A combination self-evaluation and school-home note procedure was implemented with two kindergarten boys. A single-subject reversal design was used to analyze direct observations of disruptive behavior. Results indicated a decrease in disruptive behavior associated with the intervention. The intervention procedures were also found to be acceptable by the teacher. The gap between evidence-based interventions and practice was addressed by implementing a combination of efficacious interventions in the participants' natural environment. Implications for practice and further research are presented. Keywords: Self-evaluation, school-home notes, classroom intervention, early childhood. ********** Children entering kindergarten are expected to be ready to learn. Teachers anticipate that children have readiness skills such as reciting the alphabet, knowing their name, and counting to at least 10. In addition, children entering kindergarten are expected to display age-appropriate social skills and appropriate classroom behavior. This includes paying attention to the teacher, sitting in their seat, and negotiating social situations with other young children. Young children with disruptive classroom behavior fail to meet the goal of entering school ready to learn. Inattention, impulsivity, aggression, noncompliance, and hyperactivity may impede the learning process for the child with disruptive behavior. Additionally, disruptive behavior may create an atmosphere that interferes with the learning of other children, and these behaviors often frustrate the classroom teacher (DuPaul, McGoey, Eckert, & Van Brakle, 2001). It is estimated that 3-5% of elementary age children are diagnosed with Attention Deficit/Hyperactivity Disorder, and many children with ADHD exhibit disruptive behavior in the classroom (ADHD; Barkley, 1998). Behavior management procedures have empirical support for children with ADHD and emotional and behavior disorders (DuPaul & Eckert, 1997; Pelham, Wheeler, & Chronis, 1998); however, these interventions have been primarily implemented with older elementary age children or adolescents and are often underutilized in practice (McGoey, Eckert, & DuPaul, 2000). Literature examining interventions to manage disruptive behavior of young children in the classroom have been limited in scope. Positive reinforcement, response cost, self-monitoring, and school-home note procedures have been implemented with young children, but the literature is lacking empirical support due to small sample sizes and limited replications (McGoey, et al., 2000). In addition, the interventions that have been shown to be efficacious in the scholarly literature are not always found to be as effective in classrooms (Kratochwill & Stoiber, 1999; Stoiber & Kratochwill, 1999). Therefore, applied investigations must explore the efficacy and effectiveness of classroom-based interventions (Kratochwill & Stoiber; Stoiber & Kratochwill). This lack of effective interventions for young children with disruptive behavior adds to the void between scientific research and educational practice. This study attempts to address the research to practice gap by implementing a multi-component intervention including teacher and self-evaluation via a school-home note in a kindergarten classroom. Self-management interventions have been implemented to successfully decrease disruptive behavior and increase prosocial behavior of children with emotional and behavior disorders (EBD) (DuPaul & Stoner, 2003; Mooney, Ryan, Uhingm Reid, & Epstein, 2005). Self-management techniques often require students to evaluate their own behavior, rate it on a continuum, compare that rating to the rating of the teacher, and access reinforcers for behavior meeting a pre-specified criterion. …

O comportamento de crianças em tratamento odontológico: intervenção psicofarmacológica

Este trabalho avaliou os efeitos do diazepam sobre os comportamentos de crianças com história de não-colaboração a tratamento odontológico. Foi administrado placebo ou droga (0,3mg/kg peso) a seis crianças e um total de 54 sessões foram gravadas em vídeo. A análise do registro comportamental dos participantes (choro, movimentos de corpo e/ou cabeça, fuga e esquiva) e das estratégias de manejo (distração, explicação e reforçamento positivo) sistematicamente adotadas não apontou diferença estatística significativa entre sessões placebo e diazepam pelo teste de Wilcoxon pareado (p>0,05). Sugere-se a necessidade de refinamento metodológico em estudos que combinem estratégias de manejo psicológicas e farmacológicas.

Effective Instruction Delivery and Time-In: Positive Procedures for Achieving Child Compliance

ABSTRACT The purpose of the study was to assess whether increases in compliance could be obtained in a clinic setting by using only positive procedures such as effective instruction delivery (EID) and time-in (TI). Participants were from a university-based school psychology clinic who had percentages of compliance to first-time-presented instructions of 40% or less. Each parent, trained to implement EID and TI, was assessed using a multiple baseline crossover design. Both EID and TI alone achieved increases in compliance over baseline levels and additional increases were observed when the two procedures were combined. Implications of the present use of positive behavior management procedures in the treatment of noncompliance are discussed.

Using Functional Assessment and Children's Preferences to Improve the Behavior of Young Children with Behavioral Disorders

Functional assessments conducted individually with four young children (ages 60–63 months) with behavioral disorders indicated that their behavior improved substantially when they engaged in preferred activities. An intervention in which these activities were imbedded within their existing curricula produced dramatic reductions in their problem behaviors. Probes conducted in nontargeted activities showed good generality with these children and with two nontargeted peers. Substantial increases in positive teacher interaction also occurred when the intervention was implemented. Treatment acceptability data indicated that the teachers strongly preferred the intervention over the instructional and behavior management procedures they had used previously. Finally, procedural reliability data indicated that the teachers could implement the intervention procedures properly even with limited training and support.

Social Skills Training to Increase Social Interactions Between Children with Autism and Their Typical Peers

In this study young children with autism and same-age typical peers were trained by special education teachers in social skills that (a) would be effective in a variety of situations (i.e., greeting, imitating and following instructions, sharing, taking turns, and asking for help and requesting things) and (b) were appropriate for the age and the functioning level of the children involved. Free play immediately following training was monitored to determine if the training and the feedback procedures were effective in producing an increase in positive social interactions for participants. The typical peers were given information about disabilities and received training in basic behavior management procedures in addition to the social skills training. A final component, implemented during play time, consisted of a reinforcement and feedback procedure for all children. Results showed increased frequency and duration of interactions for all target students.

Classroom Performance of Students with Serious Emotional Disturbance

The treatment effects of three types of behavior management evaluation methods—teacher evaluation, self-evaluation, and group evaluation—were investigated. Effects on both the academic and behavioral performance of students with serious emotional disturbance (SED) were examined using an alternating treatments design. Results differentiated among the three methods, indicating significantly improved academic performance when either the self- or group evaluation procedures were implemented. It could therefore be stated that students with SED can benefit from learning skills for managing their own behavior. Time spent actively engaged was found to be variable among treatments but to become consistent only during the optimal treatment phase (i.e., self-evaluation). Teacher acceptability data supported the use of all procedures although the data favored self-evaluation. The results of this initial comparative outcome study support the continued use of self- and group evaluation behavior management procedures for students with SED.

Using a Pyramid Model to Teach Behavior Management Procedures to Childcare Providers

In this study we describe and evaluate a pyramid model of staff training to teach behavior management strategies to the staff of an integrated childcare center. Using instructions, modeling, role playing, and verbal and video feedback, three co-workers were trained as specialists in the use of contingent ignoring, time-out, and verbal reprimands. Subsequently, these specialists trained other staff to implement the procedures. The results of a multiple baseline design across subjects demonstrated that the training of specialists caused improvements in performance for specialists as well as other staff, although the latter were affected to a lesser degree. Changes in child behavior also lend tentative support to the effectiveness of the pyramid model. Additionally, specialists and staff socially validated the results by indicating satisfaction with the training procedures and continuing to implement the behavior management strategies.

A FUNCTIONAL ANALYSIS OF THE COMPREHENSIVE APPLICATION OF BEHAVIOR ANALYSIS TO SCHOOLING

This study tested the effects of a comprehensive application of behavior analysis to schooling on the total trials taught, correct student trials, and objectives achieved in a small school. The package was implemented in a school for children with multiple disabilities and included a staff training program based on a personalized system of instruction, organizational behavior management procedures for supervisors, regular assessment of teacher behaviors, and teacher assessment of all instructional trials received by the 38 children to a scripted curriculum. The design was a multiple baseline across four groups of teachers and included baseline, training, and full treatment phases over a 2-year period. The results showed educationally significant increases in trials taught, correct trials, and student objectives achieved as a function of the introduction of the package. A 3rd year of follow-up data and an analysis of the turnover of staff showed that the effects of the package were maintained and that the package had social validity.