Early Behavioral Intervention Research Articles

The potential of syndrome-specific research for more effective assessment and psycho-educational intervention. Comments on Gunn and Berry’s paper

Gunn and Berry (1989, this issue) show courage. They are amongthe few researchers to face, with objectivity, the benefits literature on early intervention (EI) or Infant-Stim for Down Syndrome (DS) children. They find it wanting. Others before them have also raised the EI program efficacy issue, most notably Piper and Pless (1980), Harris (1981), Gibson and Fields (1984), Cunningham (1984, 1986), Dunst (1985), Sloper, Glenn and Cunningham (1986), Piper (1986), Weisenfeld (1987), Gordon (1987), and Gibson and Harris (1988). Notwithstanding, the effectiveness of Infant-Stim for DS infants and children continues to be vigorously supported by parent groups and career-invested professionals. By so insulating the Infant-Stim enterprise from critical evaluation, program accountability has degenerated to mere curriculum delivery system monitoring while the internal defence structure of the converted appeals increasingly to quasi-ideological positions. Yet early intervention, much more than Infant-Stim or early behavioral intervention, has enjoyed wide endorsement. There are successful surgical methods for cardiac and speech related problems, medical management for middle ear infection, vision defects, thyroid disorder, and muscular hypotonia. General health, greater alertness and increased longevity for members of the syndrome are also evident as a result of appropriate diet, guided physical activity, and watchful parenting for respiratory and other immuno-system disease risks. These «hard sciences» early interventions have produced a generation of young DS persons who project a more positive image to parents and public than did the DS child or adult during those times when «usual» treatments were not undertaken, all or most DS children were in institutions, and early mortality approached 50 percent. By comparison, the paucity of verifiable short term and more durable gains attributable solely to compensatory education techniques, especially for the cognitive and linguistic growth domains of the DS child, has generated various reformulations of Infant-Stim outcome goals to reflect whatever gains are most evident. Examples of the new enterprise of program benefits revisionism include a «system of maturational intervention» (Buckley & Sacks, 1987), a «functional model of effects assessment» (Simeonsson 1982), the «social systems benefits model» (Dundst, 1985; Zigler, 1983), an «ecological enhancement approach» (Bronfenbrenner, 1979; Marfo & Kysela, 1985) and a «personal life satisfactions concept» (Landesman, 1986). The later may prove to be the most attractive alternative if the cognitive growth goals of Infant-Stim are not eventually met by more sophisticated behavioural or biological intervention. Of these alternatives to the traditional benefits objectives for Infant-Stim, Gibson and Harris

Adaptive training for existing male transsexual gender role: A case history

. . . ng anatomlc sex. Until the 1970s, sex reassignment surgery was regarded as the main hope for transsexuals. Early behavioral interventions using aversion therapy proved unsuccessful (Gelder & Marks, 1969). More recently, however, Barlow and his colleagues have reported the successful use of behavioral procedures to change the gender identity of three adult transsexuals (Barlow, Reynolds, Agras, & Jackson, 1973; Barlow, Abel, & Blanchard, 1979). Rekers and his colleagues have also reported the successful use of external stimulus control and reinforcement control to increase traditionally masculine and decrease traditionally feminine behaviors in gender dysphoric boys (Rekers & Lovaass 1974; Rekers, Lovaas, & Low, 1974; Rekers & Varni, 1977a, 1977b). Further, Hay, Barlow, and Hay +1981) reported using covert modeling techniques successfully to increase masculine behaviors in a 10-year-old boy with gender identity confusion. In the following case report, an attempt was made to change the gender identity of a diagnosed male-to-female transsexual using a modified version of the procedure adopted by Barlow et al. 11973) and Barlow, Abel, and Blanchard (1979). Their therapeutic package involved modification of gender specific motor behavior, followed by social retraining, fantasy training, and changing sexual arousal patterns from homosexual to heterosexual. For one of their cases, treatment was terminated during fantasy training because the patient wished to retain his homosexual arousal pattern. In this case a substantial drop in transsexual attitudes occurred during social training. During follow-up, the patient reported feeling comfortable with an androgynous behavioral repertoire. This raises the question of whether to provide the patient with alternatives or to attempt a complete change. Since a complete change may not always be necessary, it may be possible to reduce dramatically the time scale for intervention.

Assessing needs for youth health promotion

Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.

Age at intervention and treatment outcome for autistic children in a comprehensive intervention program

This study compared the treatment outcomes of nine autistic children who began receiving intensive behavioral intervention prior to 60 months of age with outcomes for nine other children who entered the same intervention program after 60 months of age. The 18 children in the sample included all of the children served by the Princeton Child Development Institute's day school and treatment program during the period 1975-83 who were diagnosed autistic and who had either (a) achieved positive discharge or (b) been enrolled in the program for 24 months or longer and continued to receive program services. Age at program entry was found to be strongly related to positive treatment outcome (i.e., to children's continued residence with their natural parents and attendance at public school classes). This investigation underlines the importance of early behavioral intervention for autistic children.

Families and schools together: Early behavioral intervention with high risk children

Scatter, an index of variability of daily written classwork around the child's baseline accuracy mean, was used to identify the most inconsistent and the most stable performance among students in 13 classrooms (grades 2–5). At baseline, inconsistent students differed significantly from stable students on prior identification as educationally handicapped, math and reading classwork consistency and accuracy, and 5 self-, peer-, and teacher-rating variables. Inconsistent students were randomly assigned within classes to experimental (20) and control (20) conditions. Families of the former children wrote and carried out contracts specifying rewards for teacher-notification of a daily mean which equaled or exceeded the child's baseline mean. Intervention brought significant reductions in scatter in the target academic subject and borderline increases in accuracy and selfratings of academic success compared to the control condition. After intervention, only math and reading accuracy and teacher identification of underachievers discriminated between the stable and experimental groups. Consensus between teachers indicated clinically significant improvement in 75% of children in the experimental condition.