Receiving Behavior Modification Research Articles

Impact of an 8-Week, Intensive Summer Treatment Program on Improving Coercive Caregiver-Child Interactions Among Children With and Without Callous Unemotional Traits

The coercive process is the primary explanatory mechanism implicated in the maintenance of disruptive behavior disorders (DBDs), and understanding the coercive cycle may be especially important for caregivers with children with elevated callous-unemotional (CU) traits. The purpose of the current pilot study is twofold. First, we assessed whether the Summer Treatment Program (STP), an established intensive behavioral intervention for children with DBDs, reduced coercive caregiver-child interactions using a novel parent-report measure of coercive interactions. We then sought to assess whether the STP improved coercive caregiver-child interactions among children with elevated CU traits (i.e., moderated the effect). Thirty-three caregivers and their children who had been diagnosed with DBDs participated in the STP, which involved the children receiving behavior modification for 9 hours per day and caregivers attending a weekly behavioral parent training group session over the course of 8 weeks. Children (Mage = 8.51 years old, SD = 1.70, range 6–12) were primarily male (78.5%) and Hispanic/Latine (84.8%). A linear multilevel model revealed a statistically significant improvement in caregiver-child coercive interactions from pre- to posttreatment. However, child pretreatment CU traits moderated this effect such that families with children with elevated CU traits did not show improvement in caregiver-child coercive cycles following treatment. Results suggest the benefits of intensive behavioral treatment on the caregiver-child coercive cycle for many families, but the need to modify the intensity or dose of treatments for those with children with DBDs and elevated CU traits.

Group lifestyle modification vs. lifestyle newsletters for early childhood obesity: Pilot study in rural primary care

Research on primary-care interventions for early childhood obesity in rural communities is lacking. We compared two interventions for 4- to 8-year-old children with overweight/obesity, launched from a rural primary-care clinic. Families were randomly assigned to Intensive Lifestyle Modification (ILM; n = 23) or Lifestyle Newsletters (LN; n = 24). The primary outcome was 5-month change in child BMI z-score. ILM groups received behavior modification challenges, the Stop Light Diet, nutrition information, and parent training. LN families received by mail information on diet and physical activity. Results indicated no significant difference between groups in BMI z-score reduction ( p = 0.40; Cohen's d = 0.20), although treatment interacted with child food responsiveness ( p = 0.04) and parent perceived feeding responsibility ( p = 0.006) in exploratory analyses. Specifically, ILM compared with LN was better for children higher in ‘food responsiveness’, with a reverse pattern for children lower in this trait. ILM also was superior to LN when parents were lower in feeding responsibility, with a reverse pattern when parents were higher in this trait. Thus, the success of ILM and LN in rural primary care may depend upon child and parent attributes. Lower-intensity family interventions for early childhood obesity may offer scalable options in rural communities for some families.

Effects of behavior modification intervention on the self-care abilities of homeless patients with schizophrenia

Objective To evaluate the effect of behavior modification intervention on the self-care abilities of homeless patients with schizophrenia.Methods Totals of 52 homeless patients with schizophrenia were randomly divided into intervention group and control group with 26 cases in each group.The control group received traditional treatment and care,while intervention group received behavior modification combined with routine treatment and care.The nurses scale ( NOSIE ) was used to assess the effectiveness of treatment before the intervention and eight weeks after the intervention.Results There was no difference in NOSIE score in patients before intervention (P＞0.05).Eight weeks after intervention,NOSIE scores of social competence (35.10 ± 3.89),social interest (28.87 ± 3.08)and personal cleanliness (28.15 ± 2.41 )in intervention group were higher than (20.34 + 2.38 ),( 19.98 ± 2.54),( 21.43 ± 2.42 ) control group,and the difference was statistically significant(t =17.56,12.03,9.01,respeetively;P ＜ 0.01 ).Retardation score was (6.78 ± 2.11 ) and depression score was ( 5.23 ± 1.38 ) significantly lower than ( 11.59 ± 2.65 ),( 11.79 ± 2.65 ) in control group(t =7.61,11.2,respectively;P ＜0.01 ).The difference of irritation in two groups was not statistically significant( P ＞ 0.05 ).Conclusions Behavior modification intervention can improve self-care abilities of homeless patients with schizophrenia and can relieve working pressure of nurses in some extent. Key words: Behavior therapy; Homeless persons; Schizophrenia; Nursing intervention

PEG3350 in the Treatment of Childhood Constipation: A Multicenter, Double-Blinded, Placebo-Controlled Trial

To establish the efficacy and best starting dose of polyethylene glycol (PEG)3350 in the short-term treatment of children with functional constipation. Prospective, randomized, multicenter, double-blinded, placebo-controlled, dose-ranging study of PEG3350 in children with functional constipation. Patients were randomly assigned to either placebo or 0.2 g/kg per day, 0.4 g/kg per day, or 0.8 g/kg per day of PEG3350 after a 1 week run-in period, followed by 2 weeks of treatment. All received behavior modification. The primary outcome was the proportion of patients with a successful treatment response: >or=3 bowel movements (BM) in the second week. 103 children (mean, 8.5 +/- 3.1 years) were enrolled. 77%, 74%, and 73% of the 0.2, 0.4, and 0.8 g/kg groups were successfully treated, as compared with 42% receiving placebo (P < .04). There was a significant increase in BM (P < .001) and straining improvement (P < .05) with the different PEG3350 doses. Stool consistency improved significantly for doses 0.4 g/kg or higher (P < .001). There was more abdominal pain and fecal incontinence in patients receiving 0.8 g/kg. PEG3350 was well tolerated. This placebo-controlled study confirms the efficacy and safety of PEG3350 for the short-term treatment of children with functional constipation. We recommend a starting dose of 0.4 g/kg per day.

Effectiveness of fluoxetine chewable tablets in the treatment of canine separation anxiety

The most common signs associated with separation anxiety (SA) are destruction/rearranging behavior, vocalization, excessive salivation, inappropriate defecation, and urination. To assess a treat- ment for SA, this multi-center, placebo-controlled, double-blind, randomized parallel-arm study was undertaken with 208 client-owned dogs diagnosed with SA. After a 14-day pre-treatment period in which dog owners recorded the occurrence of 4 SA behaviors (destruction/rearranging behavior, exces- sive salivation, inappropriate defecation, inappropriate urination) daily treatment with either fluoxetine chewable tablets (FCT) at 1-2 mg/kg or placebo was given for 6 weeks. Owners scored and recorded the severity of overall (overall severity score, OSS) and individual SA behaviors weekly. At any weekly treatment interval, R58% of FCT-treated dogs had improved OSS versus pre-treatment, and compared with placebo dogs had a higher incidence of improved OSS at each week (significant at Weeks 1 and 4; P % 0.044). FCT-treated dogs showed significant improvement in incidence of destructive/rearranging behavior (P % 0.038 at Weeks 4-6) and inappropriate urination (P 5 0.045 at Week 3). Serious adverse events consisted of seizures in 1 FCT-treated dog and 1 placebo-treated dog. Neither incident had a clear association with FCT treatment. In conclusion, FCT at 1-2 mg/kg/day showed some efficacy in improving overall SA severity scores in dogs, even when used in patients not receiving behavior modification training. However, other controlled studies have shown optimal benefits from FCT administration in conjunction with behavior modification. FCT represent a viable therapy for a condition that veterinary behaviorists rank as the second most common canine behavioral disorder.

The effect of vocal hygiene and behavior modification instruction on the self-reported vocal health habits of public school music teachers

This study examined the effects of vocal hygiene and behavior modification instruction on self-reported behaviors of music teachers. Subjects ( N = 76) reported daily behaviors for eight weeks: water consumption, warm-up, talking over music/noise, vocal rest, nonverbal commands, and vocal problems. Subjects were in experimental group 1 or 2, or the control group. Both experimental groups received vocal hygiene instruction. Experimental group 2 also received behavior modification information designed to help teachers individually identify and correct their vocal problems. Results showed experimental group 2 significantly increased vocal rest and significantly decreased reports of vocal problems in the weeks closest to treatment. Although differences provide limited information, the indications stress the importance of behavior modification's inclusion in vocal hygiene programs. Individual variance implies that some subjects have difficulty managing vocal hygiene routines. Additional study of effects of multiple, varied treatment sessions may clarify the impact of treatments over extended periods of time.

THE EFFECT OF OXYBUTYNIN TREATMENT ON COGNITION IN CHILDREN WITH DIURNAL INCONTINENCE

Oxybutynin is a powerful anticholinergic drug already known to impair cognition in the elderly. The impact of this drug on cognitive functioning in the pediatric population is unknown. We report the results of a study designed to assess the effect of oxybutynin on cognitive function in children. A total of 25 patients presenting with the primary symptom of daytime enuresis were recruited for this nonrandomized trial. All subjects initially received 4 weeks of behavior modification, followed by an additional 4 weeks of behavior modification either alone or with oxybutynin for continued treatment of enuresis. Neuropsychological testing was performed at baseline (4 weeks) and after additional therapy (8 weeks). Patient demographics included a male-to-female ratio of 11:14 and a mean age of 7.2 +/- 1.8 years. A total of 10 patients were assigned to the control group receiving behavior modification, and 15 patients were assigned to the treatment group receiving behavior modification plus oxybutynin. The oxybutynin treated patients had a lower overall performance at baseline pretreatment testing. However, performance in this group improved following treatment with oxybutynin. Oxybutynin, a commonly used pharmacological agent in pediatric urology, was not associated with cognitive impairment following treatment. However, we observed lower baseline cognitive functioning in patients whose parents chose oxybutynin over behavior modification alone. This finding may represent a selection bias. However, it also supports the need for a multidisciplinary approach to the treatment of patients with dysfunctional voiding, as some may have cognitive difficulties that have not previously been explored.

Efficacy of amitriptyline as a pharmacological adjunct to behavioral modification in the management of aggressive behaviors in dogs

The efficacy of amitriptyline as a pharmacological adjunct to behavioral modification in the clinical management of aggressive behaviors in dogs was evaluated in two phases. Twelve dogs presenting for aggressive behaviors were treated sequentially with amitriptyline (2 mg/kg body weight, per os [PO] bid) and a placebo for 4 weeks in a prospective, randomized, double-blind, placebo-controlled trial. Standardized protocols for behavior modification were implemented throughout the trial. Owners maintained behavioral records and reported on the number of aggressive incidents as well as the dog's overall improvement at the end of each 4-week period. In the second phase, 27 cases of dogs presenting for aggressive behaviors and treated with amitriptyline were reviewed, and clients were contacted to record each dog's response to treatment. Reports were compared to those for dogs receiving behavior modification alone (i.e., placebo phase of prospective study). No significant difference was observed in the patients' responses to adjunctive amitriptyline versus behavior modification alone.

EFFICACY OF TWO TREATMENT APPROACHES TO REDUCE TONGUE PROTRUSION OF CHILDREN WITH DOWN SYNDROME

Five children with Down syndrome aged between 21 and 31 months, all of whom demonstrated habitual tongue protrusion, were randomly assigned to receive either oral-motor treatment or behavior modification. Tongue posture of all three children who received oral-motor treatment improved. For two of these the improvement leveled off after treatment had ended, but the third continued to show improvement. One of the two children receiving behavior modification showed improved tongue posture during treatment and maintained the improvement, but for the second there were insufficient data points to draw firm conclusions. Both forms of treatment appear to be effective, but further study is needed before definite conclusions can be made.

Predicting weight loss success among obese clients in a hospital nutrition clinic

A retrospective study of 63 obese patients seen in a hospital outpatient nutrition clinic was reported. The majority suffered from one or more other medical problems. The relationship of amount of and rate of weight loss to various factors was examined. The multivariate analysis revealed that either the amount or rate of weight loss was greater in the patients who were more overweight initially, white, male, young, single, older at age of onset of obesity, visited the clinic for a longer period of time but less frequently. Conversely, the amount or rate of weight loss was less in those patients receiving conjugated estrogens, oral contraceptives, propranolol, thioridazine HCl, and those who were receiving behavior modification as treatment.

USING BEHAVIOR THERAPY IN CONJUNCTION WITH PHARMACOTHERAPY IN TREATING HYPERACTIVE CHILDREN

Two boys diagnosed as hyperactive received behavior modification aimed toward increasing their compliance behaviors. Prior to, and during this program, both children were on a daily regimen of Ritalin, but both continued to show oppositional behaviors at home. The parents were reluctant to discontinue medication, so it was decided to use behavior therapy in combination with pharmacotherapy. Parents kept daily records of compliance behavior through a two-week baseline period (medication alone), and during a three month intervention period(behavior modification plus medication). Compliance to parental requests increased from an average of 40% on Ritalin alone to an average of 90% when behavior modification was combined with medication. Accompanying this increase in compliance was significant decrease in parental activity ratings on the Werry-Weiss-Peters Activity Scale. Additional activity ratings obtained three and six months after discontinuing formal contacts with the therapist remained at this level. It may be concluded from this study that medication was a far more effective agent for producing behavior change when combined with behavior modification, in the two children studied. Moreover, the results from these two cases suggest that medication alone may not be sufficient in treating the behavior problems often evidenced by hyperactive children.

AN EXPERIMENTAL NURSING STUDY

Ten spinal cord-injured patients at a rehabilitation center were randomly assigned to two groups: one group received behavior modification training in body positioning, the other group received customary body positioning nursing care. Body positioning behaviors were modified through demonstration of body positions and shaping of body position moves with attention from the nurse as the positive reinforcer. Following treatment, the behavior modification group showed significant change in increased frequencies of daily changes of position and patient-initiated changes of position; in decreases assistance needed for change of position, and in decreased frequencies of intervals of prolonged skin pressure. There was no significant change in frequency of face lying or participation in ward activities of daily living. Replications of the study are needed for confirmation of findings.