Decreases In Disruptive Behavior Research Articles

Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility.

Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs. A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life-sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre- and post-AFHS implementation (bed days of care [BDOC] 17413) to post-implementation (BDOC 20880). Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life-sustaining treatment documentation (82%-96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38-0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%-17.9%) and emergency department utilization (5.3%-2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 (n = 31, scale 1-100) to 81.3 (n = 42). Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.

Effectiveness of the Elos 2.0 Program, a Classroom Good Behavior Game Version in Brazil

AbstractThe Good Behavior Game (GBG) is a universal classroom behavior management method to reduce disruptive problems. This study aimed to evaluate the effectiveness of the Elos 2.0 Program, a GBG version from Brazil, on the TOCA-C subscales: concentration problems, disruptive behavior, and prosocial behavior. We evaluated 2030 children aged 6–10 years. The Elos 2.0 program had a positive effect on concentration improvement by 0.254 standard deviations (Cohen’s d = 0.254, 95%CI = 0.038–0.469), and on prosocial behavior by 0.436 standard deviations (Cohen’s d = 0.436, 95%CI = 0.139–0.734). The odds of no disruptive behavior in Elos 2.0 were 4.88 times (95%CIOR = 1.89–12.60), compared to the control group. Our findings indicate that the Elos 2.0 program is associated with modest/robust improvements in children’s prosocial and concentration skills and a decrease in disruptive behavior. This study is a preliminary support for the implementation of the Elos 2.0 Program in Brazilian public schools. REBEC/Brazil: U1111-1228–2342.

Managing middle school students' disruptive behaviors during physical education classes using the color wheel system

AbstractThis study investigated whether the use of the color wheel system (CWS) during physical education (PE) classes is associated with a significant decrease in disruptive behaviors among middle school students. Using a multiple‐baseline single‐case design, we investigated the effects of the CWS on disruptive behavior in nine middle school students with identified disruptive tendencies, aged 13.33 ± 1.1 years on average. Disruptive behaviors were tracked through observation using a 15‐s partial time sampling technique. The results, as indicated by time series graphs and Nonoverlap of All Pairs values ranging from 0.79 to 1.00, consistently demonstrated that the implementation of the CWS led to a reduction in disruptive behaviors across the three classrooms. The findings suggest that the CWS is an effective intervention for mitigating disruptive behaviors among school‐aged children during PE classes. However, it should be noted that the training procedures for implementing the CWS were relatively brief. To address potential limitations in future CWS implementations, it is recommended to address these shortcomings and carefully consider the implementation of the CWS as a behavioral intervention in PE.

The Impact of Maternal Depression on Internet-Parent–Child Interaction Therapy for Child Attention-Deficit/Hyperactivity Disorder: A Case Study

Conduct disorders and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid, with an estimated prevalence rate of 51.5% for children between 2–17 years of age (Centers for Disease Control and Prevention, 2020). Parent–Child Interaction Therapy (PCIT) is an empirically supported behavioral parent training program for children with disruptive behavior. PCIT research consistently demonstrates decreases in disruptive behaviors and increases in positive parenting strategies among families of young children with ADHD; however, PCIT has yet to become widely recognized as a treatment for ADHD. This case study presents the treatment of a 6-year-old boy with ADHD and severe behavior problems. The case was further impacted by the single mother’s depressive symptoms and internet delivery of PCIT during the COVID-19 pandemic. Findings from this case report documented an improvement in disruptive child behaviors and emotion regulation and increased positivity during parent–child interactions, despite worsening maternal depressive symptoms. This case study highlights the utility of PCIT to improve child disruptive behaviors and ADHD symptoms in the midst of several complicating factors.

The Effects of a Daily Behavior Report Card Intervention: Inclusion of a Peer Mediator

Daily Behavior Report Cards (DBRCs) have been found to decrease disruptive behaviors of children with attention-deficit/hyperactivity disorder, intellectual and developmental disorders, and typically developing students. However, although previous studies indicate that peers can assist with the implementation of a variety of interventions (e.g., Check in check out), teachers are often the implementer of DBRCs. In addition, it appears that no studies evaluating DBRCs have included a functional assessment. Thus, the purposes of this study were to assess the effects of a peer-mediated DBRC on disruptive classroom behaviors, determine whether peers could implement their portion of the intervention procedures with high integrity, and assess whether DBRC was effective independent of the functional reinforcer for disruptive behavior. In this study, peer-mediated DBRC led to a decrease in disruptive behavior and an increase in on-task behavior for all three target students who were at risk for EBD. The peer mediators also implemented the DBRC procedures with high integrity. Furthermore, DBRC was effective at suppressing disruptive behavior independent of their presumed functional reinforcer. However, it does appear that different portions of the intervention likely addressed the hypothesized functions of problem behaviors of all three participants.

Using Class Pass Intervention to Decrease Disruptive Behavior in Young Children

Previous research has shown that disruptive behavior can impair students’ academic success (Pierce et al. in Remedial Spec Educ 25:175–188, 2004, https://doi.org/10.1177/07419325040250030501 ), as well as increase teacher’s stress level (Westling in Remedial Spec Educ 31:48–63, 2010, https://doi.org/10.1177/0741932508327466 ). The Class Pass Intervention (CPI) is a Tier 2 intervention designed to decrease disruptive behavior and increase academic engagement; however, few studies have evaluated the efficacy of CPI. The purpose of this study was to assess the effects of CPI on disruptive behavior and academic engagement of young students who engage in disruptive behavior. This study used a non-concurrent multiple baseline design to assess experimental control. In the current study, CPI led to a decrease in disruptive behavior and an increase in academic engagement for all three participants and these levels persisted throughout schedule thinning. In addition, results of teacher and student social validity assessments indicated that the intervention was effective and easy to implement and that students preferred the intervention.

Combining Social Skills Instruction and the Good Behavior Game to Support Students with Emotional and Behavioral Disorders

Research indicates that students with emotional and behavioral disorders (EBD) may engage in severe disruptions and off-task behaviors in the classroom setting that adversely impact the learning environment. This leads to many students identified as having EBD being placed in alternative education settings, such as restrictive schools or residential facilities. Due to placement in more restrictive environments and high rates of disciplinary actions, it is especially critical to decrease disruptive behaviors for students diagnosed with EBD. In addition, classroom teachers report disruptive behaviors and conduct problems as a major barrier to teaching their students. An ABC multiple baseline across classes design was used in an alternative school setting to evaluate the effects of explicit social skills training combined with a group contingency on class-wide levels of engagement and disruptive behavior. Participants were students in the first through sixth grade diagnosed with EBD. Through the class-wide intervention, social skills acquisition deficits were targeted through social skills instruction and social skills performance deficits were targeted through reinforcement programs. Results showed an increase in engagement and a decrease in disruptive behavior across all classrooms as a result of the intervention package.

Brief Report: A Preliminary Investigation of a Mindful Breathing Intervention to Increase Academic Engagement in an Alternative Educational Setting

The current study used a multiple-baseline across subjects design to examine the effect of a daily, audio-delivered, mindful breathing intervention on adolescents with emotional and behavioral difficulties attending an alternative educational setting. Academic engagement served as the primary dependent variable, with disruptive behavior, feasibility, and acceptability serving as secondary dependent variables. Four students entered the baseline phase; however, only two students entered the intervention phase. Results indicated that participants displayed increases in academic engagement as measured by both direct behavior rating and systematic direct observation that were maintained at 6-week follow-up. Decreases in disruptive behavior were also observed. Because the effects were not replicated three times, changes cannot be directly attributed to the intervention. In addition, teachers and students perceived the intervention to be both feasible and acceptable. Implications of the findings are discussed.

Effects of Tootling on Classwide and Individual Disruptive and Academically Engaged Behavior of Lower‐Elementary Students

The current study was designed to replicate and extend the literature on the effectiveness of a classroom intervention known as Tootling, a strategy that encourages and prompts students to report instances of their peers' positive behaviors. The purpose of the present study was to assess the effects of the Tootling intervention on decreasing classwide and individual target students' disruptive behavior as well as increasing classwide and individual target students' academic engagement in lower elementary, general education classrooms using a criterion number of tootles that could reasonably be attained daily, thus potentially allowing more immediate and frequent access to reinforcement. Participants included second and third graders and their teachers in three classrooms in two Southeastern elementary schools. An ABAB withdrawal design was used in the three classrooms, along with a multiple baseline element across two of the classrooms, to determine the effectiveness of the intervention. Results demonstrated decreases in disruptive behaviors and increases in academically engaged behaviors during intervention phases as compared to baseline and withdrawal phases in all classrooms. Effect sizes were moderate to large for all comparisons. Limitations of the present study, directions for future research, and implications for practice are discussed. Copyright © 2016 John Wiley &amp; Sons, Ltd.

THE CLASSROOM PASSWORD: A CLASS-WIDE INTERVENTION TO INCREASE ACADEMIC ENGAGEMENT

The present study investigated the effectiveness of a novel class-wide intervention, the Classroom Password, for increasing the academic engaged behavior of middle school students. The effectiveness of an independent group contingency was evaluated using a concurrent multiple baseline design across three seventh- and eighth-grade classrooms. Results indicated that the intervention was effective across all three classrooms in increasing students’ academic engagement, or on-task behavior, as evidenced by visual analysis and moderate to large effect sizes. Decreases in disruptive behavior were also observed across all three classrooms. Off-task behavior was not substantially affected in any of the three classrooms. The intervention received mixed ratings by the classroom teachers regarding its social validity. Results of the present study suggest that the Classroom Password may be an effective class-wide intervention for increasing the academically engaged behavior and decreasing the disruptive behavior of middle school students during instructional time.

Technology delivered self-monitoring application to promote successful inclusion of an elementary student with autism

ABSTRACTThe ever-increasing prevalence of children diagnosed with autism spectrum disorder (ASD) is paralleled in public educational settings, including general education classrooms. Challenges with social/behavioral functioning, including limited self-management and behavior inhibition, can lead to off-task and disruptive behaviors that interfere with acquisition of academic and social skills. Without effective and efficient interventions, opportunities to participate in inclusive settings will likely be reduced. Self-monitoring (SM) is an intervention with strong evidence for increasing prosocial behaviors and decreasing challenging behaviors for students with ASD in educational settings, although the cuing mechanisms (e.g., timers, stopwatch) and tracking materials (e.g., paper, pencil) can be cumbersome and obtrusive. I-Connect is an SM application that allows for customizable prompts, recording, and data monitoring. The purpose of this study was to evaluate, utilizing an ABAB design, the functional relationship between implementation of I-Connect SM intervention and increases in on-task behavior with concurrent decreases in disruptive behavior for an elementary student with ASD in a general education classroom. Results indicate an immediate increase in on-task behavior as well as a decrease in disruptive behaviors with each introduction of I-Connect. Implications for practice and future research are discussed.

Contextual variation in young children's observed disruptive behavior on the DB-DOS: implications for early identification.

Contextual variation in child disruptive behavior is well documented but remains poorly understood. We first examine how variation in observed disruptive behavior across interactional contexts is associated with maternal reports of contextual variation in oppositional-defiant behavior and functional impairment. Second, we test whether child inhibitory control explains the magnitude of contextual variation in observed disruptive behavior. Participants are 497 young children (mean age = 4 years, 11 months) from a subsample of the MAPS, a sociodemographically diverse pediatric sample, enriched for risk of disruptive behavior. Observed anger modulation and behavioral regulation problems were coded on the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) during interactions with parent and examiner. Oppositional-defiant behavior, and impairment in relationships, with parents and nonparental adults, were measured with the Preschool Age Psychiatric Assessment (PAPA) interview with the mother. Functional impairment in the home and out-and-about was assessed with the Family Life Impairment Scale (FLIS), and expulsion from child care/school was measured with the baseline survey and FLIS. Observed disruptive behavior on the DB-DOS Parent Context was associated with oppositional-defiant behavior with parents, and with impairment at home and out-and-about. Observed disruptive behavior with the Examiner was associated with oppositional-defiant behavior with both parents and nonparental adults, impairment in relationships with nonparental adults, and child care/school expulsion. Differences in observed disruptive behavior in the Parent versus Examiner Contexts was related to the differences in maternal reports of oppositional-defiant behavior with parents versus nonparental adults. Children with larger decreases in disruptive behavior from Parent to Examiner Context had better inhibitory control and fewer attention-deficit/hyperactivity disorder symptoms. The DB-DOS showed clinical utility in a community sample for identifying contextual variation that maps onto reported oppositional-defiant behavior and functioning across contexts. Elucidating the implications of contextual variation for early identification and targeted prevention is an important area for future research.

Effects of and preference for conditions of token earn versus token loss.

The effects of earning and losing tokens on the disruptive behavior of 12 first-grade students were evaluated under symmetrical contingencies of earn and loss. Both contingencies produced decreases in disruptive behavior. For some participants, more consistent decreases were observed during the loss contingency. In addition, participants generally earned or kept more tokens during the loss contingency. When offered a choice of contingencies, most participants preferred the loss contingency. The results showed some consistency with behavioral economic principles of loss aversion and the endowment effect.

A Case Study of Parent–Child Interaction Therapy for the Treatment of Autism Spectrum Disorder

Comorbid disruptive behavior disorders occur in up to 80% of children with Autism Spectrum Disorder (ASD). Children with ASD often present as inattentive, noncompliant, and aggressive, making it difficult for them to engage in learning and social activities across settings. Parents and school staff report spending excessive time managing disruptive behaviors at the expense of engaging these children in meaningful skill development. Identifying effective interventions to decrease disruptive behaviors and increase positive skill development is of critical importance to improving outcomes for children with ASD. This case study presents the effectiveness of Parent–Child Interaction Therapy, an evidence-based intervention for young children with disruptive behavior, for addressing behavioral problems in a 7-year-old boy with ASD. Results suggested improvements in child compliance and decrease in disruptive behaviors. Further, parents increased their use of positive parenting strategies, including giving effective commands all of which serve to improve the parent–child relationship. Treatment implications for working with young children with ASD are discussed.

EXTENDING SELF‐MANAGEMENT STRATEGIES: THE USE OF A CLASSWIDE APPROACH

Notwithstanding the wealth of research that documents the effectiveness of self‐management programs in the classroom, few investigations have explored classwide use of self‐management procedures as a universal intervention. To extend existing research in this area, we examined the effectiveness of a classwide self‐management intervention for decreasing disruptive behaviors among three at‐risk second‐grade students. We used a multiple baseline across subjects design and evaluated the effects of the self‐management program at both the individual and classwide levels during academic instruction time. Results of the study showed a decrease in disruptive behaviors of the target students and a general decrease in classroom disruptive behavior. In addition, teachers and students provided positive ratings of intervention acceptability and feasibility. Limitations, implications, and future directions for research are discussed.

CHILD DISRUPTIVE BEHAVIOR AND PARENTING EFFICACY: A COMPARISON OF THE EFFECTS OF TWO MODELS OF INSIGHTS

In this article, we investigate the effectiveness of INSIGHTS into Children's Temperament (INSIGHTS), a temperament-based preventive intervention, in reducing the disruptive behavior problems of young children from low-income, urban families. Results indicate that children enrolled in INSIGHTS evidenced a decrease in disruptive behavior problems over the course of the intervention, with children with high maintenance temperaments evidencing the most rapid rates of decline. In addition, children in a collaborative version of the program with joint parent and teacher sessions demonstrated more rapid decreases in disruptive behavior than children in a parallel version with separate parent and teacher sessions. Furthermore, high maintenance children in the collaborative intervention evidenced lower levels of disruptive behaviors at the end of the intervention than their peers in the parallel version. Increases in parenting efficacy appeared to be the mechanism through which INSIGHTS reduced child disruptive behavior.

Use of a Daily Report Card in an Intervention Package Involving Home-School Communication to Reduce Disruptive Behavior in Preschoolers

The effectiveness of a daily report card in an intervention package involving home-school communication to decrease disruptive behavior in preschoolers was investigated. A sample of four preschool-aged children in two classrooms served as participants. Teachers rated behavior three times daily for each participant using a daily report card. Ratings were shared with the student and then parent, and contingent reinforcement involving positive praise and stickers was provided. A concurrent multiple baseline across-participants design was employed, with results demonstrating decreases in disruptive behavior for all students. Overall, results indicated the daily report card intervention with a home-school component to be an effective method for decreasing problem behavior in a preschool setting.

Using an iPod Touch to Teach Social and Self-Management Skills to an Elementary Student with Emotional/Behavioral Disorders

A ten year-old boy exhibiting frequent off-task and disruptive behavior during small group math instruction was taught to use an iPod Touch for video modeling and self-monitoring purposes. A single-subject changing conditions (A-B-BC) design was used to investigate the differential effects of video modeling versus a combination of video modeling and self-monitoring. During the first intervention phase, immediately prior to participating in a math group, the student viewed a 3-minute video in which peers modeled appropriate math group behavior. Video modeling resulted in a significant increase in on-task behavior and decrease in disruptive behavior. However, results showed variability across sessions. For the second intervention phase, the student was taught to self-monitor his behavior during math group. A combination of video modeling and self-monitoring then resulted in a consistent increase in percent of intervals on-task (near 100%), as well as consistently low levels of targeted disruptive behavior.

THE EFFECTS OF FIXED‐TIME ESCAPE ON INAPPROPRIATE AND APPROPRIATE CLASSROOM BEHAVIOR

Few studies have explored the effects of fixed-time (FT) reinforcement on escape-maintained behavior of students in a classroom setting. We measured the effects of an FT schedule on the disruptive and appropriate academic behaviors of 2 junior high students in a public school setting. Results demonstrated that FT escape from tasks resulted in a substantial decrease in disruptive behavior and an increase in time engaged in tasks for both participants.

The Utilization and Effects of Positive Behavior Support Strategies on an Urban School Playground

Rates of problem behavior at urban elementary school playgrounds are of growing concern. The purpose of this study was to examine how the implementation of a recess intervention within the context of School-wide Positive Behavior Support (SwPBS), a systemwide, team-driven, data-based decision-making continuum of support, affected disruptive student behavior and teacher supervision on the playground in an urban elementary school. Specifically, this study replicated investigations conducted by Lewis and colleagues through teaching recess-related behaviors to students and using group contingencies to reinforce appropriate student behaviors. A multiple baseline design was used to assess the effects of SwPBS on the frequency of five target behaviors. Results indicated decreases in disruptive behaviors across three grade levels and increases in active teacher supervision.