Behavioral Assessment Procedures Research Articles

Behavioural assessment and treatment of chronic headaches in children.

This review explores advances in the behavioural assessment and treatment of childhood headaches. Behavioural assessment procedures are outlined including the behavioural interview, self-report questionnaires, self-monitoring and caregiver observations. We conclude that behavioural treatment strategies are effective in the management of childhood headaches, although most of the research support appears to be limited to relaxation training and biofeedback. Nonetheless, the behavioural assessment and treatment of childhood headaches appears to be a promising clinical and research direction.

Behavioral assessment of feeding problems of individuals with severe disabilities.

As many as 80% of the individuals with severe or profound mental retardation exhibit feeding problems. Although behavioral interventions have been used to treat these problems, no assessment procedure for determining a functional relationship between a person's acceptance of food and the type and texture of that food has been reported. The purpose of this study was to test a behavioral assessment procedure for a feeding problem of limited intake. Five individuals with severe or profound mental retardation were fed 10 to 12 types of foods with one or more textures. Behavioral categories of acceptance, rejection, expulsion, and other negative behavior were recorded. Results indicated that each subject fit into one of four categories of feeding problems: (a) total refusal, (b) type selectivity, (c) texture selectivity, or (d) type and texture selectivity. Thus, although all 5 subjects exhibited limited intake, the food characteristics correlated with the problem were different for each individual. Results suggest that treatments for limited intake may be based on assessments that show the association of food type or texture to a person's rejection or expulsion of food.

Aerobic fitness level (VO2max) moderates the increased cardiovascular function and basal thromboxane formation of young healthy Type A males.

The authors evaluated the interaction between physical fitness and Type A behavior on vascular production of prostacyclin and platelet thromboxane in response to a standard vessel injury. Ninety-seven male university students were classified as Type A or B on the basis of the Structured Interview of Rosenman. Reactivity, as measured by changes in systolic blood pressure (SBP), and heart rate (HR), measured before and after a stressful Stroop task 1 week later, showed that Type A individuals were more reactive to the stressor than Type Bs, providing independent confirmation of the behavioral interview assessment procedure. Fitness level was determined by a graded treadmill test and was not different for Type As and Type Bs. Basal thromboxane production, measured as the primary metabolite, thromboxane B2, in blood oozing from the bleeding-time site, was highest among unfit Type A subjects. Fit Type As and Type Bs showed significantly lower thromboxane production. No significant differences in prostacyclin production were seen. This study marks the first time that behavior pattern has been linked to an adverse aspect of a thrombosis-related parameter likely to be involved in the genesis of cardiovascular disease. The present results also indicate that physical fitness may, in some fashion, ameliorate the "toxic" effects of Type A behavior.

Increasing the Effectiveness of the National Cholesterol Education Program: Dietary and Behavioral Interventions for Clinical Settings

Abstract The National Cholesterol Education Program (NCEP) is the cornerstone of primary care efforts to treat hypercholesterolemia. It provides diagnostic criteria and an outline of appropriate assessment and treatment protocols. The initial treatment emphasis is on the Step 1, low-cholesterol, low-fat diet. A review of these guidelines from a behavioral perspective suggests that there may be several areas of concern. These include: (a) the absence of attention given to developing sufficient motivation for behavior change; (b) the limited efficacy of routine dietary education for promoting dietary changes; (c) the apparent need for diets more rigorous than the Step 1 and Step 2 guidelines to substantially lower cholesterol in some individuals; (d) the extensive support such dietary interventions must have from established behavioral change strategies; and (e) the lack of enthusiasm and experience many physicians and other medical personnel have for nutrition interventions. It is suggested that more conceptually-based behavioral assessment procedures, such as those based upon the stages of change model, could broaden the impact of the NCEP. In addition, data are presented which suggest that the NCEP could have greater effectiveness if more exacting behavioral strategies are followed. Interactive, multimedia systems are discussed as one means to facilitate dietary interventions in primary care settings. Finally, the importance of integrating measures designed to enhance long-term maintenance of dietary modifications is emphasized along with the need for more ongoing research within the NCEP.

Hypokinesia, rigidity, and tremor induced by hypothalamic 6-OHDA lesions in the rat

Bilateral administration of 6-hydroxydopamine in the medial forebrain bundle at the level of the posterolateral hypothalamus in rats resulted in hypokinesia, muscular rigidity and tremor as determined by various behavioral assessment procedures. These neurological signs were accompanied by marked decreases in the concentrations of dopamine and its main metabolites dihydroxyphenylacetic acid and homovanillic acid in both striatum and nucleus accumbens. Administration of apomorphine (1 mg/kg) or L-Dopa (60 mg/kg) reversed or totally abolished the hypokinesia, rigidity and tremor in lesioned animals. Together, the present findings demonstrate that bilateral intrahypothalamic administration of 6-OHDA results in the appearance of the three cardinal symptoms of Parkinson's disease in rats. This model should prove to be valuable for both the study of the neuropathological processes underlying the neurological signs of this disease and the screening of potential antiparkinson agents.

USE OF NEGATIVE REINFORCEMENT IN THE TREATMENT OF SELF‐INJURIOUS BEHAVIOR

Behavioral assessment procedures were used to determine the maintaining conditions of self-injury exhibited by 2 children with severe multiple handicaps. For both children, negative reinforcement (escape from grooming activities) was determined to be the maintaining reinforcer for self-injury (hand/arm biting) within an alternating treatments design. The treatment packages involved the use of negative reinforcement (brief escape from grooming activities) contingent upon a behavior that was incompatible with self-injury (reaching and pressing a microswitch that activated a pre-recorded message of "stop"). Treatment was evaluated with a reversal design for 1 child and with a multiple baseline across grooming activities for the 2nd child. The treatment led to a marked decrease in self-injury for both children. At follow-up, high rates of self-injury were reported for the 1st child, but low rates of self-injury and an increase in task-related appropriate behavior were observed for the 2nd child.

A Behavioral Evaluation of Curriculum-Based Assessment of Reading

This study was designed to examine the effects of setting and method accuracy in Curriculum-Based Assessment (CBA), based on Cone's (1981, 1987) elaboration of a methodology for validating behavioral assessment procedures. The effects of who administered the assessment (teacher vs. author), the physical location of the assessment (reading group vs. teacher's desk vs. office outside classroom), and whether the performance was timed or untimed were examined for oral reading rates of 26 third- and fourth-grade students in a regular education classroom. The effects of these conditions on the number of words read correctly per minute (WC) and the percentage of errors (%E) were examined in three separate studies. Results showed significant effects for the tester, setting, and task demand variables on WC scores and significant effects for the task demand variables on%E scores. Implications of these results are addressed, and the needed research in this area is discussed.

THE USE OF BEHAVIORAL ASSESSMENT TO PRESCRIBE AND EVALUATE TREATMENTS FOR SEVERELY HANDICAPPED CHILDREN

Behavioral assessment procedures were used to prescribe and evaluate treatments of maladaptive behavior for 2 children with severe multiple handicaps. In Experiment 1, the results of an assessment of reinforcer preference were used in conjunction with a functional analysis of the conditions maintaining self-injurious behavior to prescribe a treatment for a child with severe disabilities. The treatment procedure involved the use of a pressure-sensitive microswitch to activate reinforcing stimuli during two solitary conditions, during which self-injurious behavior had occurred at high rates. The results were evaluated with a multiple baseline across settings design and indicated that self-injury decreased with concomitant increases in microswitch activation. Results were maintained at 6 weeks, 8 weeks, and 6 months. In Experiment 2, the results of behavioral assessments of reinforcer preference and self-injurious behavior were combined to develop a treatment for a second severely handicapped child, who exhibited high rates of self-injury in demand situations. This treatment was evaluated with a multiple baseline across tasks design and resulted in the elimination of self-injury for up to 15 months.

Behavioral assessment and treatment of overanxious disorder in children and adolescents.

This article reviews recent advances in research evaluating the characteristics and epidemiology, diagnostic reliability, methods of assessment, and proposed treatment for children and adolescents with overanxious disorder. Empirical findings to date show that overanxious disorder is a frequently occurring phenomenon in childhood and adolescence that merits further attention from researchers. Directions for future studies aimed at identifying useful behavioral assessment procedures and effective therapeutic interventions for this disorder are outlined.

College classroom interaction as a function of teacher- and student-centered instruction

Regional campus college students participated in traditionally or nontraditionally taught sections of undergraduate introductory educational psychology. The nontraditional sections were student centered, involving personal goal setting and monitoring conferences, and informal group discussion tests. The traditional sections were teacher centered, involving a lecture format, formal tests and assignments, and comparative grades. An event sampling behavioral assessment procedure was used to record student and teacher behaviors according to the following verbal interaction response categories: positive, negative, questions, answers, presents, solicits, shares, generates, impedes. The course sections were analyzed and found to be comparable with regard to teachers' positive responses and information presented, as well as content acquisition and final grades. However, students in the nontraditional course section asked significantly more questions, shared more information, and generated more ideas than students in the more traditional teacher-centered course. Replication analyses supported the initial findings regarding learning and attitudinal differences favoring student centered course sections over teacher centered sections.

Psychological aspects of painful medical conditions in children. I. Developmental aspects and assessment

The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. There has been very little research on the developmental aspects of pain tolerance and pain threshold in children. There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed.

Insomnia: nonpharmacologic management by private practice physicians.

We report a survey investigation on the perceived value of behavioral assessment and the use of nonpharmacologic treatment of insomnia by 159 physicians in private practice in Davidson County, Tennessee. They generally attributed limited value to behavioral assessment, and reported infrequent use of nonpharmacologic treatment. However, the more patients the physicians saw with insomnia as the chief symptom, the more they tended to value behavioral assessment and other diagnostic procedures. Endorsement of behavioral assessment and all other diagnostic practices was in turn related to the use of behavioral treatment techniques. We suggest that a lack of awareness of the value of alternative assessment and treatment strategies may account for physicians' limited use of nonpharmacologic approaches to this common yet frequently serious medical problem.

Behavioural assessment of disturbed, institutionalized retardates.

While behavioural assessment has had wide application in a number of educational and treatment settings, relatively little has been done to develop programmes specifically for use with retardates who have been institutionalized for the treatment of disturbed behaviour. As a result, the development of appropriate procedures for the latter group requires extrapolation from the use of behavioural techniques in other settings. The current literature on behavioural assessment stresses the importance of identifying meaningful response units and their controlling variables, if efficacious treatment programmes are to be mounted. To be maximally useful, assessment must provide a relatively simple description in objective, non-inferential terms of how a patient responds to the demands of daily living. While many reports of treatment programmes focus on the assessment of a single, narrowly defined variable, the occurrence of which can be readily counted, this is not appropriate for the initial assessment procedures of a residential treatment centre. What is required is an omnibus approach which samples the patient's responses to a broad array of environmental situations which are relevant to the centre and its population. A review of available behavioural scales reveals that there are very few reliable omnibus scales available for use with retardates and none which adequately assesses the behavioural concommitants of disturbed retardates. To deal with this group of patients, it is proposed that, initially, two scales be used to sample both normal and maladaptive behaviour. A number of suggestions have been made for implementing behavioural assessment procedures in residential treatment centres, especially for disturbed retardates.

Methodology and Cognitive—Behavioral Assessment

In the most recent edition of the Annual Review of Behavior Therapy (Franks et al., 1982) the point is made that behavioral assessment has moved simultaneously in two different directions. In one direction we see the heartland of assessment being entered via a more basic concern with the reliability and validity of behavioral assessment procedures. In the other direction we observe behavioral assessment to be taking a wider cut, expanding into the arena of cognitive-behavioral assessment. While the reasons for the reliability and validity studies may be apparent (i.e. to assure psychometric credibility), some have questioned the soundness and legitimacy of our excursion into the “mind”.

Is a B.A.T. Therapeutic?

Recent years have seen a growing concern in the psychometric properties of behavioural assessment procedures. The present study addresses itself to the question of the possible reactivity of the behavioural assessment of fear, a situation predicted both by the experimental extinction and incubation models.In a single case study it was found that a 50% reduction in self-reported fear was associated with the behavioural assessment, though there was no evidence of a reduction of fear associated with “verbal therapy”. It is suggested that: (i) behavioural assessments of fear are reactive; (ii) that they produce a reduction in fear; and (iii) that this is consistent with an extinction model.

Predicting client attrition from psychotherapy through behavioral assessment procedures and a critical response approach.

Adults who requested outpatient psychotherapy completed a pretreatment questionnaire after admission and a posttreatment questionnaire immediately after the first therapy session. Questionnaire items concerned the client's situation at the time of the request for treatment (e.g., distance travelled to the clinic), past behavior in fulfilling commitments, self-prediction of session attendance, and reaction to the initial interview. Five items were related significantly to continuation in two separate S samples. A critical response scale comprised of 14 items and responses proved highly predictive of the number of treatment sessions attended in both initial (N = 78) and cross-validational groups (N = 91).

Behavioral Assessment Technique as a Clinical Intervention

Behavioral assessment procedures have been used to predict the onset of addictive behaviors. However, no controlled studies have been conducted to demonstrate the usefulness of such procedures in the treatment of drug abuse. A group using the Behavioral Assessment Technique (BAT) as an indicator for clinical intervention was compared to a group in which the BAT was not used clinically. The results indicated that the BAT was not particularly effective for clinical purposes. This failure was independent of the BAT's accuracy in predicting drug usage. Alternative hypotheses were discussed.

UNOBTRUSIVE MEASURES IN BEHAVIORAL ASSESSMENT

A major distinguishing characteristic of behavioral assessment is the direct assessment of overt behavior. Direct assessment is assumed to provide a sample of behavior that reflects client performance in the situation in which behavior is assessed, even if the assessment procedures were not implemented. Yet, in the majority of investigations, behavioral assessment procedures are obtrusive, i.e., subjects are aware that their behavior is being assessed. The potential problem with obtrusive assessment is that it may be reactive, i.e., affect how subjects perform. Recent research has demonstrated that obtrusive observations often are reactive and that behaviors assessed under obtrusive and unobtrusive conditions bear little relation. From methodological and applied perspectives, additional attention needs to be given to unobtrusive measures of behavior change. The present paper illustrates unobtrusive measures in behavior modification including direct observations, archival records, and physical traces of performance. In addition, validation and assessment problems, questions about the obtrusiveness of the measures, and ethical issues are discussed.

Selecting a cost-effective screening measure for the assessment of preschool social withdrawal.

The utility of teacher judgment (rankings, ratings) and peer judgment (sociometric ratings) were studied as screening variables for preschool social withdrawal/responsiveness. Observational measures of preschoolers' interaction were used as the validation criterion based upon theoretical, empirical, and practical considerations related to development of a multipurpose behavioral assessment system. Results indicated that teacher rankings of students' verbal interaction frequencies (1) were most highly correlated to interaction rate in two preschool settings, (2) had test-retest reliability consistently above Rho = .80, and (3) were useful in that 77% of teachers using this procedure could identify their least socially responsive student within five rankings. The peer nomination sociometric rating was the least reliable measure at retest (Rho = .35) and showed consistently the lowest correlation with observational indices of interaction partner preferences, e.g., reciprocal rate (Rho = .29 to .39). The tendency for relationships among screening measures and the criterion to increase at retest suggested a training effect on screening accuracy. The use of teacher rankings in combination with observational measures to confirm selection accuracy and for monitoring treatment progress is discussed as a cost-effective behavioral assessment procedure for preschool social withdrawal/responsiveness.

Recent Africana on Malnutrition and Behaviour: A Special Review

Eastern, Southern and Western African studies on the effects of malnutrition on behaviour are reviewed. The studies are briefly described in terms of the behavioural assessment procedures employed, the nature of the malnutrition involved, the age-groups studies and conclusions drawn on the basis of the results of the research. Comment on the studies is also made. From the review it becomes clear that studies on chronic and acute malnutrition may yield considerably different results in terms of behavioural sequelae.