Multiple-baseline Across-subjects Design Research Articles

Efficacy of EMDR in Body Dysmorphic Disorder and Associated Cognitive-Emotional Features

Body dysmorphic disorder (BDD) is a severe psychological disorder that significantly impacts functioning and quality of life. Eeye movement desensitization and reprocessing (EMDR) presents as an emerging alternate psychological intervention. This study aimed to examine the efficacy of EMDR in BDD symptoms and associated cognitive-emotional features. These features include appearance-based rejection sensitivity, body shame, and self-compassion. Our study utilized a multiple-baseline across-subjects design, monitoring four randomly allocated female patients with BDD over a 10-session/90-minute EMDR treatment phase and two follow-up sessions at 1 and 3 months, respectively. Our results showed that EMDR significantly reduced BDD symptoms (recovery percentage [RP] = 60.54), appearance-based rejection sensitivity (RP = 36.56), and body shame (RP = 54.82) and increased self-compassion (RP = 51.79). Therefore, our study suggests that EMDR may be an effective treatment for BDD patients.

Effects of Horseback Riding on the Postural Control of Autistic Children: A Multiple Baseline Across-subjects Design.

The aim of this research was to study the effect of a horseback-riding programme on postural control in a group of autistic children (ASD). Nine children aged 9 to 12 years participated in this study through a multiple baseline across subjects design. The whole programme took place over nine months. Participants followed a previously developed specific horseback-riding programme, consisting of 45-minute sessions held twice a week for at least three months. To evaluate postural control, the average velocity of the centre of pressure displacement was measured by means of a posturographic platform. Results indicated that this intervention with horses had a positive effect on the postural control in children with ASDs.

EMDR therapy for PTSD symptoms in patients with mild intellectual disability or borderline intellectual functioning and comorbid psychotic disorder: A case series

BackgroundLittle is known about the effectiveness of EMDR therapy for PTSD symptoms in persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50–85) and psychosis. AimsTo examine effectiveness, feasibility, and safety of eye movement desensitization and reprocessing (EMDR) therapy in six patients with MID-BIF, PTSD and psychotic disorder. Methods and proceduresData were collected in a multiple baseline across-subjects design. Before, during and after treatment, weekly assessments on PTSD symptoms and adverse events were carried out. PTSD classification was assessed, and severity of hallucinations, delusions, and general psychopathology were measured at pretreatment, posttreatment and three-month follow-up. Outcomes and resultsThere were no dropouts and five of the six participants completed treatment early. They showed a decrease in PTSD symptom severity and did no longer meet DSM-5 PTSD criteria at posttreatment. Results were maintained at follow-up. Symptoms did not exacerbate as indicated by a significant decrease in general psychopathology (in five participants) and an improvement in general functioning. In five participants severity of psychotic symptoms decreased. Conclusions and implicationsEMDR therapy is safe and feasible and the results suggest that it can be an effective treatment for PTSD in patients with triple mental health problems in a tertiary mental health treatment setting.

CAN-flip: A Pilot Gymnastics Program for Children With Cerebral Palsy.

This pilot study examined whether an adapted gymnastics program, CAN-flip, could be a feasible activity for children with cerebral palsy (CP) leading to improvements in muscle fitness, motor performance, and physical self-perception. Four girls and 1 boy (9.8 ± 1.3 yr) with CP participated in this multiple-baseline across-subjects design and were randomly assigned to start either the 6-wk gymnastics or the 6-wk control period. Muscle strength, neuromuscular activation, range of motion, gross motor performance, balance, and physical self-perception were assessed at baseline, after the first 6-wk period, and at the conclusion of the study. The gymnastics program comprised two 1-hr individualized classes per week. All participants were able to complete the gymnastics classes without injury and showed improvement in specific gymnastics skills. In addition, 3 of the 5 participants registered for regular gymnastics classes after the study, demonstrating the program's usability as a link to inclusive gymnastic classes.

Parent-Assisted Cognitive-Behavioural Therapy for Children's Nighttime Fear

Nighttime fear, including fear of monsters and the dark, is common. For most children and adolescents, nighttime fears are transient. However, approximately 10% experience severe nighttime fear that negatively impacts sleep, adjustment, and family life. Research conducted in the 1980s indicates that cognitive-behavioural therapy can reduce nighttime fear in as few as three sessions. The aims of the present study were to replicate and extend earlier research by evaluating a cognitive-behavioural treatment package for children's severe nighttime fear, and address methodological issues in previous studies. A manualised, multi-component treatment package was developed, based on current evidence-based practice for the treatment of children's anxiety. Interventions included graded exposure, muscle relaxation, cognitive restructuring, and social and material reinforcement. Treatment was individually tailored and delivered via weekly modules. A multiple baseline across-subjects design was utilised. Four ‘families’ — one parent and one child — participated; children's ages ranged from 6 to 10 years. Families attended five weekly intervention sessions and a 1-month follow-up. Multiple outcome measures were administered pre- and post-treatment. All children displayed changes consistent with reduced nighttime fear following treatment, including fewer phobic symptoms, reduced general fear, and improved nighttime and general behaviour. These changes were maintained at follow-up. Parents reported a high degree of satisfaction with the program and would recommend it to other families. The results support the effectiveness of manualised, parent-assisted treatment for nighttime fear in as few as three sessions. In cases of severe nighttime fear, therapist support is recommended. Treatment implications for children with complex presentations are discussed.

Virtual-Reality-Based Social Interaction Training for Children with High-Functioning Autism

ABSTRACT Employing the multiple-baseline across-subjects design, the authors examined the implementation and potential effect of a virtual-reality-based social interaction program on the interaction and communication performance of children with high functioning autism. The data were collected via behavior observation and analysis, questionnaires, and interviewing. The children participants demonstrated increased performance of responding, initiation, greeting, and positive conversation-ending during the intervention, and improved social competence measures after the intervention. The study also contributed salient themes on the adaptive design of a virtual-reality-based learning environment for learners with special needs. The study findings should extend the discussion on the design and usage of technology-supported informal learning environment for children with diverse characteristics and learning needs.

Posttraumatic Stress Disorder and Social Support in Female Victims of Sexual Assault

The goal of this study is to enhance the efficacy of CBT with victims of sexual assault suffering from PTSD by getting the spouse involved. Thus, in addition to attempting to reduce PTSD symptoms, the therapy focuses on improving the support offered by the spouse and favors management of the impact of the traumatic event within the couple. A single-case, multiple-baseline across-subjects design is used. Three victims of sexual assault with a diagnosis of PTSD participated in the study. Results at posttreatment and at 3-month follow-up are promising. None of the participants presents a diagnosis of PTSD, and all report a significant improvement in their satisfaction with the support received from their spouses.

The Effects of Instruction in an Inference Strategy on the Reading Comprehension Skills of Adolescents with Disabilities

The purpose of this study was to determine the effects of teaching eight secondary students with disabilities, including seven with learning disabilities, a strategy for answering a variety of inferential questions. A multiple-baseline across-subjects design was employed. Outcome measures included scores on researcher-devised comprehension quizzes, a standardized test of reading comprehension, a strategy use test, a strategy knowledge test, and a reading satisfaction measure. Fidelity of implementation, instructional time, and maintenance of skills were also measured. Results suggest that students with disabilities can learn to use a strategy to answer a variety of inferential questions, and mastery of its use can result in improved scores on criterion-based and standardized measures of reading comprehension. In addition, students' satisfaction with their reading improved.

Supporting Young Children's Literacy Learning through Home-School Partnerships: The Effectiveness of a Home Repeated-Reading Intervention

The purpose of this study was to examine the effectiveness of a home repeated-reading intervention on the reading achievement of eight low-performing second-grade children in an urban school by taking into consideration their need to develop automaticity and the role their parents play in this process. Specifically we posed the following questions: Does participation in a home repeated reading intervention improve children's (a) reading accuracy, (b) reading fluency, and (c) reading skills on an independent reading task? When parents participate in a home repeated reading intervention, (a) what word-study strategies do they use to support their children's reading and (b) how do the strategies they use influence children's subsequent word errors? A multiple-baseline across-subjects design and a pre-post design were used to assess the effectiveness of the intervention. Results indicated that all participants made substantially fewer reading errors during the intervention as compared to their performance on baseline stories. All participants demonstrated decreased error rates from the first to the last reading of stories, and significant fluency gains were evident in all cases when comparing mean baseline fluency with mean intervention fluency. All participants made considerable gains in fluency from the first to the last reading of each story, and all children improved on an independent reading measure. All participants read more than 10,000 words during the home intervention. Parents monitored their children's home reading. Four parents provided substantial word-level support, and the children who received this support made fewer repeated reading errors.The children who begin school with full, or nearly full, literacy pocketbooks, in terms of the dominant literacy Discourse, will consistently and inevitably outperform, outlearn, and outscore those children who arrive at the school door with considerably less. While it is the responsibility of the schools to teach what is needed, programs that focus on increasing the level and degree of literacy in the homes of children have begun and are desperately needed. (Purcell-Gates, 1995, pp. 198–199)

Language-based retrieval difficulties in arithmetic: A single case intervention study comparing two children with SLI

The aim of this single-case intervention study was to examine whether difficulties in fluently retrieving language-based material are related to learning to retrieve arithmetical facts from long-term memory. Two 10-year-old Finnish-speaking children considered to have Specific Language Impairment (SLI) were trained individually twice a week for two months using computerised game-like addition tasks. The participants were matched for non-verbal reasoning and non-verbal numerical skills as well as linguistic skills (verbal short-term memory, comprehension and vocabulary). The key cognitive difference between the participants was naming fluency. Child A had difficulties in fluently retrieving language-based material while child B’s performance on the same task was close to age-mean. A multiple baseline across-subjects design was used, with three baseline assessments and three follow-up assessments. Before the intervention both children used finger-counting strategies only. During the intervention child B progressed from finger-counting strategies to fact retrieval, while child A continued to use finger counting only. The results suggest that the benefit of an intervention programme, focusing on teaching fluent calculation skills with simple additions, is related to the specific features of the child’s language competencies. It is proposed that an inability to shift from a finger counting to a fact retrieval strategy is connected to difficulties in fluent retrieval of language-based material from long-term memory.

Practicing School Consultants Can Empirically Validate Interventions

ABSTRACT The purpose of this manuscript is to describe and demonstrate how practicing school psychologists who are serving as consultants can empirically validate interventions using the non-concurrent multiple-baseline across-subjects (Non-Con M-B A-S) design. Over the course of a school year, three teachers, from different elementary schools, each referred a student for behavioral consultation. In each case, the target problem was insufficient journal writing, and the teacher and consultant developed interventions consisting of goal setting, self-monitoring, self-graphing, and reinforcement. Data from the three behavioral consultation cases were combined to form a Non-Con M-B A-S design. Results showed immediate and sustained increases in students' journal writing after the intervention was implemented. Discussion focuses on applied and experimental strengths and limitations associated with practicing school consultants' use of the Non-Con M-B A-S design.

Sequential Treatment for Chronic Insomnia: A Pilot Study

This article explores the efficacy of sequential treatment involving medication and cognitive behavioral treatment (CBT) for insomnia. In a multiple baseline across-subjects design, 6 participants with primary chronic insomnia received 1 of the following treatment sequences: (a) concurrent combination of medication and CBT for the 10-week treatment duration (Combined); (b) medication for the first 5 weeks, with introduction of CBT at week 4 and medication withdrawal after the 5th week resulting in treatment overlap during weeks 4 and 5 (Overlapping: Medication → Combined → CBT); and (c) medication alone for the first 5 weeks followed by CBT alone for an additional 5 weeks (Medication → CBT). Each sequence led to significant sleep improvements, but these improvements occurred at different times during the intervention. Participants in the Combined and in the Overlapping sequences improved their sleep during the 1st phase of treatment, whereas those in the Medication → CBT sequence improved mostly during the 2nd phase of treatment. These preliminary results suggest that a sequential treatment is effective for chronic insomnia. In addition, the results suggest that sleep improvements are more likely to emerge when CBT is introduced, with an Overlapping sequence showing a slight advantage over the other sequences. Additional clinical trials should be conducted with larger samples to replicate these preliminary findings.

Errorless Academic Compliance Training: Improving Generalized Cooperation With Parental Requests in Children With Autism

Children with autism often demonstrate distress and oppositionality when exposed to requests to complete academic or household tasks. Errorless academic compliance training is a success-focused, noncoercive intervention for improving child cooperation with such activities. In the present study, the authors evaluated treatment and generalization effects of this intervention on four children diagnosed with autism. In a multiple baseline across-subjects design, parents delivered a range of academic and nonacademic requests to their children to determine the probability of compliance for each request. A hierarchy of academic requests ranging from those yielding high compliance (level 1) to those yielding low compliance (level 4) was then developed. Treatment began with the concentrated delivery of level 1 requests, with praise and reward for compliant responses. Over several weeks, children were gradually introduced to requests from subsequent probability levels with continued reward for compliance. High compliance levels were demonstrated throughout and following treatment. Evidence of generalization to untrained academic requests and nonacademic requests emerged. Treatment gains were maintained up to 6 months after treatment. Errorless academic compliance training appears to be an effective intervention for enhancing generalized compliance in children with autism.

Efficacy of virtual reality exposure therapy for driving phobia: A multiple baseline across-subjects design

A multiple baseline across-subjects design was used to examine the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. The treatment consisted of 8 weekly graded VRET sessions. Using self-monitoring and interview measures, treatment efficacy was examined across 5 participants. Three participants had reductions in driving phobia symptoms, while there was little change in the remaining individuals. VRET did not result in an increase of actual driving frequency for any of the participants. Some gains were lost at the 1- and 3-month follow-up, particularly for the participants who showed weaker treatment responses. Four individuals completed the 1-year follow-up and their symptoms remained largely unchanged. Given the modest treatment outcome and lack of generalization to actual driving behavior, VRET may be most useful as a supplement or preparatory intervention for in vivo exposure, rather than a stand-alone intervention.

Preliminary Research on the Efficacy of Virtual Reality Exposure Therapy to Treat Driving Phobia

This article presents a review of preliminary research of two studies of the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. Study 1 describes a case study of a patient who completed a 7-day baseline followed by three sessions of VRET. Her peak anxiety decreased within and across sessions. At the post-treatment assessment, her phobic-related symptoms had diminished and she no longer met diagnostic criteria for driving phobia. Clinical improvement was maintained at 1-, 3-, and 7-month follow-up. In study 2, a multiple baseline across-subjects design was used to treat five patients over eight weekly VRET sessions. Visual and statistical analyses showed clear improvement in driving anxiety and avoidance in three patients between pre- and post-treatment assessments, and they no longer met criteria for driving phobia. There was marginal improvement in one patient, and the remaining individual showed no treatment gains. There was negligible change in actual driving frequency for any of the patients. Some gains were lost at the follow-up, particularly for the two individuals with poorer treatment responses. The results from these preliminary studies suggest that VRET may be a promising intervention for treating driving phobia. Avenues for improving treatment outcome are discussed.

The Effects of Social Skills Instruction on the Social Behaviors of Students at Risk for Emotional or Behavioral Disorders

The authors examined the effects of pullout small-group and teacher-directed classroom-based social skills instruction on the social behaviors of five third- and fourth-grade students at risk for emotional or behavioral disorders. A multiple-baseline across-subjects design was conducted to determine whether the combination of small-group and classroom-based social skills instruction would reduce the frequency of antisocial behaviors across two settings (i.e., classroom, lunchroom). Results of the study indicated moderate reductions in antisocial behaviors during small-group social skills instruction. The positive changes either further declined or were maintained after classroom social skills instruction commenced. Training variables are discussed.

Teaching Students with Severe Emotional or Behavioral Disorders to Use a Musical Mnemonic Technique to Solve Basic Division Calculations

A multiple-baseline across-subjects design using a multiple-probe technique was employed to functionally assess the effects of teaching three students with severe emotional or behavioral disorders to use a mnemonic to solve basic division fact calculations. The results of this pilot study indicate that instruction in the use of the technique did increase the percentage of correct basic division facts calculated on independent work samples for all three students. The discussion reflects the authors’ optimism about the potential of the use of mnemonics with students with emotional or behavioral disorders and suggests the need for further research, as well as methodological considerations for that research.

Errorless compliance training: Building a cooperative relationship between parents with brain injury and their oppositional children.

Errorless compliance training, a noncoercive intervention for improving child compliance, was evaluated in a multiple baseline across-subjects design with 12 oppositional children (ages 2-7 years) and their brain-injured parents, who suffered from cognitive deficits, impulsivity, and/or emotional instability. Generalized and durable increases were observed in child compliance after treatment. Pre/post improvements were also noted on a measure of parent self-esteem. Errorless compliance training may be well suited to intervention with parents with cognitive and behavioral impairments that decrease their potential to benefit from traditional parenting approaches.

The Effects of Behavioural Contracting and Preferred Reinforcement on Appointment Keeping

AbstractThe current study demonstrates the efficacy of using a behavioural contingency contract in conjunction with family-selected reinforcers to increase appointment keeping among low income families in a child and family therapy clinic. Three families with similar presenting problems participated. A multiple baseline across-subjects design with the addition of a reversal component was utilised. Upon treatment implementation, contracts were signed by family members stating that they would receive coupons valuing $30.00 after attending four consecutive clinic appointments. These coupons were selected by the family from a diverse menu. Results indicated increases in appointment keeping following implementation of the behavioural contract. The cost effectiveness of using a behavioural contract in conjunction with economic incentives with low-income families is discussed, and suggestions for future research on appointment keeping are made.

The Effects of a Multimodal Intervention Program on Performers: II. Training the Butterflies to Fly in Formation

The purpose of this study was to examine the effects of a multimodal intervention on swimmers debilitated by anxiety. A staggered single-subject multiple-baseline across-subjects design was used over 10 competitive races for 4 swimmers. Baseline observations on cognitive and somatic anxiety “direction” (facilitative/debilitating) scores were collected for three, four, and five races for Participants 2, 3, and 4, respectively, prior to treatment. The intervention was designed based on qualitative data from Hanton and Jones’s (1999) study and included the skills of goal setting, imagery, and self-talk. These psychological skills emerged as particularly important from Hanton and Jones’s investigation as a means of maintaining facilitative interpretations of precompetition anxiety symptoms. Preintervention, all participants reported debilitating interpretations of cognitive and somatic anxiety symptoms. However, post intervention, the 3 participants who received treatment reported facilitative interpretations. Performance improvements were also evident for these swimmers. A postintervention follow-up showed that swimmers’ interpretations were still facilitative.