Improvements In Problem Behaviors Research Articles

Effects of Multicomponent Case Management on the Problem Behaviors of Patients With Dementia and Family Caregivers' Distress, Self-Efficacy, Depression, Burden and Health Promotion Behaviors

Few of the interventions currently available for family caregivers (FCGs) of persons with dementia (PWDs) with long-term follow-ups have a grounding in theory and incorporate multicomponent case management formats. Based on Pearlin's Caregiving and Stress Process model, this study was developed to examine the effectiveness of a family-centered case management program for PWDs with early to moderate dementia in terms of reducing PWDs behavioral problems and improve FCG outcomes, including distress, self-efficacy, depression, caregiver burden, and health-promoting behaviors. This randomized, single-blind, parallel-controlled trial included 76 dyads of PWDs and their FCGs. The dyads were recruited from outpatient clinics at dementia centers in three district hospitals in northern Taiwan. The dyads were randomly assigned to the intervention group (IG, n = 39) and control group (CG, n = 37). The dyads in the IG received a four-month intervention with two home or clinic visits and two telephone interviews. The multi-component interventions provided assessment, education, consultations, support, and referrals to long-term care resources. The CG received routine care and two social phone calls. Data were collected upon enrollment (T0 = baseline) and at 4-,6-, and 12-months post-intervention (T1, T2, and T3, respectively). Generalized estimating equations were conducted to analyze the effects of the intervention. By controlling for the interaction between group and time, we made a comparison between IG and the CG. The results showed significant improvements from baseline measures in behavioral problems in the PWDs for mood, psychosis, and social engagement, and improvements in the FCGs for distress and self-efficacy for obtaining respite as well as for better control of distressing thoughts, feelings of depression, caregiver burden, and overall health promoting behaviors at T1 and T2 (p < 0.5). Significant improvements were also found in the IG for psychomotor regulation among PWDs and the self-efficacy of FCGs in managing the PWDs' disturbing behaviors and health promotion behaviors for nutrition at T1 (p < 0.5). There were no significant improvements in the outcome variables at T3. Significant interactions between group and time were found at the 6-month assessment (T2) for improvements in problem behaviors of PWDs and depression, caregiver burden, and distress in the FCGs. Positive effects on self-efficacy and health promotion behaviors among the FCGs were also achieved. The results suggest that a multicomponent case management intervention should be referenced in dementia care policymaking for FCGs and PWDs.

Long-Term Treatment Outcomes of PEERS® for Preschoolers: A Parent-Mediated Social Skills Training Program for Children with Autism Spectrum Disorder

Although parent-assisted social skills interventions may reduce early social challenges in preschool-aged children with autism spectrum disorder (ASD), limited research has explored whether intervention gains maintain several years after treatment. This study examined the durability of PEERS® for Preschoolers, a parent-mediated social skills training program for preschool-aged children with ASD and other social challenges. Twenty-nine parents reported on child and family outcomes 1–5 years following treatment. Results demonstrated maintenance of treatment gains on measures of ASD-related social impairments including social communication, social responsiveness, social motivation, and peer engagement. Post-treatment improvements in problem behaviors and parenting stress were not maintained at long-term follow-up. Implications of these results are discussed.

RUBI parent training as a group intervention for children with autism: A community pilot study

BackgroundChildren with autism spectrum disorder (ASD) frequently present with co-occurring problem behaviors that interfere with daily living skills and educational placement. The Research Units in Behavioral Intervention (RUBI) parent training manualized intervention was developed as a stand-alone intervention for problem behavior in children with ASD. Group-based parent training options are a low-cost alternative that allow providers to simultaneously serve multiple clients. Currently, no community feasibility studies exist examining the RUBI Parent Training program when delivered as a group intervention. MethodThis study sought to provide preliminary evidence supporting the use of the RUBI Parent Training program as a group intervention. The manualized RUBI Parent Training intervention was delivered to four small groups of caregivers (N = 11) of children (M age = 4.82 years) with ASD. Feasibility data were collected on treatment acceptability, fidelity, and effectiveness. Exploratory treatment effectiveness was evaluated through structured observations of child compliance and parent-report of child problem behavior. ResultsOverall, the group-implemented RUBI Parent Training program was found to be feasible as demonstrated by high levels of parent acceptableness, attendance, and treatment fidelity. Additionally, the majority of the children demonstrated improvements in problem behavior. ConclusionsThe current findings provide initial support for the delivery of the RUBI Parent Training in a group of parents. This could provide a cost-effective alternative for the treatment of problem behavior in children with ASD.

Improvements in problem behavior in a child with autism spectrum diagnosis through synthesized analysis and treatment: A replication in an EIBI home program

A recent study described a synthesized treatment where a functional analysis was based on an open‐ended interview and combined with functional communication and delay‐tolerance training. The treatment resulted in a reduction in problem behaviors and an increase in appropriate requests. Most of the analysis and intervention were done in a clinic setting, and required weekly visits by the family. This present study is a systematic replication, where we conducted the same synthesized treatments, with a young child with Autism Spectrum Disorder (ASD) enrolled in a home‐based Early Intensive Behavior Intervention program, EIBI. Outcomes were similar with a marked reduction in problem behaviors and an increase in appropriate requests. These findings suggest that it is possible to conduct this intervention in a home setting, with weekly consultations with parents. Our study show the utility of the synthesized treatment in an EIBI program in a home setting and how this can contribute to client time and costs.

Relato de um caso de Transtorno Obsessico-Compulsivo infantil à luz da Análise do Comportamento

A análise funcional é a principal ferramenta que auxilia o terapeuta analítico-comportamental nas decisões de intervenções mais adequadas durante o processo terapêutico. O presente artigo teve como objetivo principal relatar as principais análises funcionais realizadas por uma terapeuta no decorrer de um atendimento em terapia analítico-comportamental infantil (TACI). Este caso retrata um processo diagnóstico de transtorno obsessivo-compulsivo (TOC) de uma criança de cinco anos de idade, || e foi interpretado com ênfase mais em critérios funcionais do que topográficos e foi interpretado com ênfase em critérios funcionais mais do que nos topográficos. Os comportamentos-alvo selecionados (todos sendo parte do espectro obsessivo-compulsivo), analisados funcionalmente, e com intervenções bem descritas, propunham diminuir a apresentação destes, entretanto sem a pretensão de suprimi-los completamente. Este estudo de caso permitiu verificar melhora significativa nos comportamentos-problema apresentados inicialmente pela cliente, e assim constatar a efetividade das análises realizadas e da escolha das intervenções.

Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments

Problem behaviors like self-injury, aggression, or disruption will likely require intervention at some point in the life of a person diagnosed with autism. Behavioral intervention has been proven to be effective for addressing these problems, especially when a functional assessment is conducted. Comprehensive treatment for problem behavior is, however, often fractured across studies, resulting in a dearth of studies that show socially validated improvements in these problem behaviors or illustrate the assessment and treatment process from start to finish. In this article, we describe an effective, comprehensive, and parent-validated functional assessment and treatment process for the severe problem behaviors of 3 children with autism. After an 8- to 14-week outpatient clinic consultation, no problem behavior was observed at the clinic and in the home. Furthermore, behavior that did not occur during baseline (e.g., functional communication, delay and denial tolerance, and compliance with instructions) occurred with regularity.

Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes

Dialectical behavior therapy (DBT) was originally developed for chronically suicidal adults with borderline personality disorder (BPD) and emotion dysregulation. Randomized controlled trials (RCTs) indicate DBT is associated with improvements in problem behaviors, including suicide ideation and behavior, non-suicidal self-injury (NSSI), attrition, and hospitalization. Positive outcomes with adults have prompted researchers to adapt DBT for adolescents. Given this interest in DBT for adolescents, it is important to review the theoretical rationale and the evidence base for this treatment and its adaptations. A solid theoretical foundation allows for adequate evaluation of content, structural, and developmental adaptations and provides a framework for understanding which symptoms or behaviors are expected to improve with treatment and why. We first summarize the adult DBT literature, including theory, treatment structure and content, and outcome research. Then, we review theoretical underpinnings, adaptations, and outcomes of DBT for adolescents. DBT has been adapted for adolescents with various psychiatric disorders (i.e., BPD, mood disorders, externalizing disorders, eating disorders, trichotillomania) and problem behaviors (i.e., suicide ideation and behavior, NSSI) across several settings (i.e., outpatient, day program, inpatient, residential, correctional facility). The rationale for using DBT with these adolescents rests in the common underlying dysfunction in emotion regulation among the aforementioned disorders and problem behaviors. Thus, the theoretical underpinnings of DBT suggest that this treatment is likely to be beneficial for adolescents with a broad array of emotion regulation difficulties, particularly underregulation of emotion resulting in behavioral excess. Results from open and quasi-experimental adolescent studies are promising; however, RCTs are sorely needed.

Behavioral Intervention for Problem Behavior in Children With Fragile X Syndrome

Parents and professionals typically report problem behavior as a significant concern for children with fragile X syndrome. In the present study, the authors explored whether behaviorally based interventions would result in a reduction in problem behavior and an improvement in quality of life for 3 children with fragile X syndrome and their families. A multiple baseline design was used to demonstrate intervention effects for specific high-priority contexts (i.e., bedtime, running errands, and toileting). A multicomponent intervention plan was developed to teach the parents and child to effectively cope with the particular context. After intervention, there were substantial improvements in problem behavior and family quality of life within the given contexts. Results of this study demonstrated the effectiveness of behavioral intervention for children with fragile X syndrome.

The Effectiveness of Parent–Child Interaction Therapy for Families of Children on the Autism Spectrum

We report the results of a pilot trial of an evidence-based treatment-Parent-Child Interaction Therapy (PCIT; Eyberg et al. Psychopharmacology Bulletin, 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of shared positive affect during the course of therapy on child and parent outcomes. The intervention group showed reductions in parent perceptions of child problem behaviors and child atypicality, as well as an increase in child adaptability. Shared positive affect in parent child dyads and parent positive affect increased between the initial and final phases of the therapy. Parent positive affect after the first phase was related to perceptions of improvement in problem behaviors and adaptive functioning.

A meta-analytic inquiry into the relationship between selected risk factors and problem behavior.

Identifying the predictors of problem behavior is essential both for understanding the causes of such behavior and for preventing it. Although a great deal of research has sought to identify the factors predictive of problem behavior, much of the research to date has been correlational and tells us little about causality. This study attempts to improve on the correlational research by applying meta-analytic techniques to existing experimental and quasi-experimental studies of school-based prevention. The following 3 risk factors were examined: academic performance, bonding to school, and social competency skills. The most convincing evidence of a relationship between risk and problem behavior was found for bonding to school. Positive changes in attachment and commitment to school resulting from the preventive interventions were consistently accompanied by positive changes in problem behavior. Preventive interventions that produced improvements in academic performance produced moderate improvements in problem behavior. With regard to social competence, the association depended in large part on the type of measure used to assess social competency skills. Changes in self-report measures of social competency were unrelated to changes in problem behavior, whereas a strong positive correlation was observed between changes in ratings and observations of social competency by others and improvements in problem behavior.