Severe Behavioral Problems Research Articles

Examining the Effectiveness of a Variable Momentary Differential Reinforcement of Other Behavior Procedure on Reduction and Maintenance of Problem Behavior

To evaluate the effectiveness of variable-momentary differential reinforcement of other behavior (VM DRO) schedules in the reduction and maintenance of problem behavior. Specifically, will VM DRO be effective in reducing severe problem behavior for two children diagnosed with developmental disorders (DD)? Differential reinforcement of other behavior (DRO) has been demonstrated to be effective in reducing severe problem behavior for decades. However, recent manipulations to the schedule of delivery have led to advancements in DRO. Indicatively, VM DRO has been an effective intervention for automatically reinforced as well as social-positive maintained behavior for individuals with developmental disabilities. There is a dearth of research on variable- and fixed-momentary DRO schedules for individuals with DD; therefore, more examinations may be necessary. Two case studies of individuals who had been diagnosed with developmental disabilities were reviewed. Functional analyses were conducted and indicated that problem behavior for both participants was maintained by social-positive reinforcement. VM DRO was effective at reducing one participant’s problem behavior. Fixed interval differential reinforcement of other behavior (FI DRO) was effective at reducing the other participant’s problem behavior. Findings suggest that VM DRO may not be effective at reducing problem behavior for all individuals and that outcomes may be idiosyncratic.

Changing developmental trajectory in high-risk families: the effectiveness of an attachment-informed Therapeutic Nursery Program (TNP) for preschool children with complex emotional and behavioral problems

ABSTRACT The article describes a “Therapeutic Nursery Program“ (TNP) and presents a study that examined its effectiveness. This attachment-informed program serves preschoolers with severe emotional and behavioral problems. Efficacy was assessed based on: 1) children’s success in transitioning from the TNP to typical schools; (2) improvement in children’s outcomes as a function of specific intervention factors; (3) gains in social informational processing during the school year. The sample included 60 children from mostly low-income African American families (>60%). Nearly 80 percent of graduates attended typical educational settings after graduation. More classroom attendance and more individual child therapy sessions were associated with better social, academic, and cognitive child outcomes. Finally, TNP children with better attendanceclosed the gap with a comparison group in their social information processing. Our findings point to the TNP as a promising prevention approach with specific implications for the practice of attachment in the ”real world.”

Tree Canopy Coverage Predicts Lower Conduct Problem Severity in Children with ASD

ABSTRACTIntroduction: Conduct problems are commonly reported among individuals with autism spectrum disorders (ASD) and children with other special health care needs (CSHCN). Environmental research indicates that exposure to natural environments can lead to decreased conduct problems; opposite effects (i.e., increased problems) are associated with built “gray” environments (e.g., roadways).Methods: This exploratory study analyzed the association between Zip-code level tree canopy coverage and severity of conduct problems in typical children, children with ASD, and CSHCN. Tree canopy data came from National Land Cover Database and ASD data came from the cross-sectional National Survey of Children’s Health (2011/2012).Results: Percent tree canopy coverage predicted a decreased risk of severe conduct problems in youth with ASD, but not CSHCN; “gray” space was unassociated with conduct problems in any children.Conclusions: Community tree canopy coverage is negatively associated with conduct problems in children with ASD. More research using individual assessments and street level metrics will help better determine the relationship between canopy coverage and conduct problems in ASD.

Classroom Climate, Identification with School, and General Self-worth Predict Academic Self-Concept in Students Attending Residential Schools for Special Education

ABSTRACT Most youth in residential youth care institutions have a long history of adverse childhood experiences, and show (severe) emotional, behavioral, and academic problems. The present study used adolescent self-report questionnaires to examine associations between living group climate, classroom climate, identification with school, general self-worth and academic self-concept of students attending schools for special education in residential youth care institutions in the Netherlands. The sample consisted of 184 adolescents (63.6% male, age M = 16.40, SD = 1.99) with severe emotional and behavioral problems. Results showed a weak association between living group climate and classroom climate, and somewhat stronger associations between classroom climate, identification with school and general self-worth on the one hand and academic self-concept on the other hand. We conclude that group workers and teachers should collaborate for the benefit of integrated care and education in residential youth care facilities.

Examining the Links Between Received Network Support and Marital Quality Among Mothers of Children with ASD: A Longitudinal Mediation Analysis.

Employing a cohort sequential design and multilevel modeling, the direct and indirect effects (via depressed mood, emotional wellbeing, and perceived support) of received network support on marital quality were assessed over a 7-year period (child age 7-14) on 96 married or cohabiting mothers of children with ASD. Findings indicated several significant direct and indirect effects affecting change within mothers over time, with effects varying by whether the support source was a spouse or partner, family members, or friends. In addition, one moderated mediation effect was noted, with the indirect effect of received spousal support on marital quality via perceived spousal support retaining significance only at low and moderate levels of child problem behavior severity. Study strengths, limitations, and clinical implications are discussed.

Emotion Regulation and Attrition in Parent–Child Interaction Therapy

As evidence of the importance of emotion regulation (ER) continues to mount, little is known about how families dealing with child behavior problems can better develop this important ability. We explored the relations among a caregiver training program for children with severe problem behavior (Parent–Child Interaction Therapy; PCIT), child ER, caregiver ER, parenting stress, and attrition. This study was part of a larger investigation evaluating the impact of incentives on treatment outcomes. Measures of caregiver and child ER, child behavior problems, and parenting stress were completed by caregivers referred for PCIT from a predominantly low-income community sample of 66 caregiver–child dyads. Caregiver–child interactions were coded for caregiver verbalizations during three play situations. ANCOVA, t-test, and correlational analyses were conducted to examine changes in ER across treatment and compare those who completed treatment with those who dropped out of treatment early. Caregiver ER and child ER lability/negativity improved significantly across both phases of PCIT. Child adaptive ER improved significantly from pre- to post-treatment and during the second phase of treatment for those children in the non-incentives group only. Baseline levels of child and caregiver ER were not significant predictors of attrition. Findings are discussed with respect to the importance of both caregiver and child ER in the provision of PCIT and other behavioral parent training programs.

A longitudinal examination of interactions between autism symptom severity and parenting behaviors in predicting change in child behavior problems

BackgroundChildren with autism spectrum disorder (ASD) often exhibit behavior problems, with more severe ASD symptomatology relating to more severe behavior problems. Behavior problems are correlated with parenting behaviors; however, less research has investigated the relations among specific parenting behaviors and change in child behavior problems, particularly among children with ASD. MethodThis study examined the interactions among Time 1 ASD symptom severity and parenting behaviors (positive and negative) when predicting Time 2 child internalizing and externalizing behaviors (analyzed separately), when accounting for Time 1 child behavior, caregiver distress, caregiver sex, and child age. The sample included 129 caregivers of a child with ASD (ages 4–10 years) who completed two online questionnaires one year apart, which included measures assessing ASD symptom severity, child behavior problems, parenting behaviors, and caregiver distress. ResultsAcross two hierarchical multiple regression analyses, Time 1 child behavior, caregiver distress, caregiver sex, and negative parenting predicted unique variance in Time 2 child externalizing and internalizing behaviors. The interactions between ASD symptom severity and negative parenting predicting externalizing behaviors and ASD symptom severity and negative parenting predicting internalizing behaviors were significant. ConclusionsExamination of plots of the significant interactions suggested higher levels of negative parenting may exacerbate later behavioral problems and lower levels of negative parenting may protect against later behavioral problems for children with less severe ASD symptoms but not for those with more severe ASD symptoms. Results have implications for interventions targeting parenting practices for children with ASD.

Topography of behavior problems among children with neurodevelopmental conditions: Profile differences and overlaps.

This exploratory proof of principle study examined the extent to which behavior problems represent a functional characteristic that crosses diagnostic boundaries. This cross-sectional study pertains to 179 caregivers of children, aged 4-13 years (M = 8.27) with cerebral palsy (n = 77), autism spectrum disorder (n = 58), and global developmental delay/intellectual disability (n = 44). Caregivers completed the Strengths and Difficulties Questionnaire, which provides a measure of conduct problems, emotional symptoms, hyperactivity-inattention, peer problems, as well as total difficulties. Behavior problem severity differed across diagnostic groups (p < .001). Visual examination of box plots indicated substantial overlap within Strengths and Difficulties Questionnaire subscales across children with autism spectrum disorder, cerebral palsy, and global developmental delay/intellectual disability. Children within each condition demonstrated matching profile topographies, such that hyperactivity-inattention difficulties were most severe. Repeated measures analysis of variances confirmed that children within each group received significantly higher ratings on the hyperactivity-inattention subscale (all p < .001). The approach adopted to examine the data and findings have the potential to inform how we conceptualize and study behavior problems among children with neurodevelopmental conditions. Importantly, children with particular conditions did not demonstrate unique constellations of difficulties. Clinicians must therefore be attuned to the possibility of commonality in behavior problems across children with disparate diagnoses, irrespective of syndrome-specific expectations.

Commentary: Money can't buy you love, but lack of love costs families and society plenty - a comment on Bachmann et al. (2019).

The target paper on the costs of (lack of) love underscores the ongoing need for early preventive interventions that support parents, both mothers and fathers, aiming to provide for their children. With effective targeting of such interventions, the emergence of children's antisocial behavioral problems may be greatly lessened. In addition to the economic costs to family and society of caring for children with moderate or severe antisocial behavior problems is substantial, the costs in terms of diminished health and well-being may persist across the lifespan. Recent research on attachment and physical health adds to the evidence base pointing to the substantial economic burdens, falling to families, schools, and health services, when insecurity or disorganization of attachment typifies early parent-child relationships. Further research ought to give consideration to potentially moderating or compensatory relationships that otherwise vulnerable youth may develop to supportive peers, siblings or teachers.

Children with Behavioural Problems Misinterpret the Emotions and Intentions of Others

Research indicates that the misinterpretation of other’s emotions or intentions may lead to antisocial behaviour. This study investigated emotion and intention recognition in children with behavioural problems and examined their relationship and relations with behaviour problem severity. Participants were 7–11 year old children with behavioural problems (n = 93, mean age: 8.78, 82.8% male) who were taking part in an early intervention program and typically developing controls (n = 44, mean age: 9.82, 79.5% male). Participants completed emotion recognition and Theory of Mind tasks. Teachers and parents rated children’s emotional and behavioural problems. Children with behavioural problems showed impaired emotion and intention recognition. Emotion recognition and intention recognition were positively related and inversely associated with behavioural problem severity and, independently of one another, predicted behavioural problems. This study is the first to show that children with behavioural problems are impaired in identifying others’ emotions as well as intentions. These social cognitive processes were found to be related and inversely associated with severity of behavioural problems. This has important implications for intervention and prevention programmes for children with behavioural difficulties.

Detailed assessment and risk factor analysis of corticosteroid-induced psychiatric disorders in pediatric, adolescent, and young adult patients undergoing induction or consolidation therapy for hematologic malignancy.

Corticosteroid-induced psychiatric disorders (CIPDs) represent an adverse effect that can cause severe emotional and behavioral problems. The aim of the present study was to assess the incidence and risk factors of CIPDs. A retrospective analysis of 92 pediatric and young adult patients with hematologic malignancies was conducted. The incidence of CIPDs in patients receiving a treatment regimen with prednisolone or dexamethasone was 64.9% and 77.5%, respectively, both of which were significantly higher than that in patients not receiving corticosteroids. Independent risk factors and adjusted odds ratios (95% confidence intervals) related to severe CIPD were 2.15 (1.11-4.18) for dexamethasone (using prednisolone as the reference) and 0.81 (0.75-0.87) for age, suggesting that the odds increase with decreasing age. Frequently observed symptoms, respectively in terms of behavioral and emotional problems were defiance, crying, psychomotor excitement, dysphoria, irritability, and depression. To our knowledge, this is the first report to mention the risk factors and characteristics for clinical symptoms of CIPDs during the developmental process. Healthcare professionals should predict and prepare for psychiatric adverse events prior to chemotherapy in the clinical settings, especially in patients in younger age and receiving a treatment regimen with dexamethasone.

A Pilot Randomized Controlled Trial of Cannabidiol to Reduce Severe Behavioral Problems in Children and Adolescents With Intellectual Disability

Severe behavioral problems (SBPs) are a common contributor to morbidity and reduced quality of life in children with intellectual disability (ID). Medications commonly used for the treatment of SBPs in ID are associated with a high risk of side effects. Innovative and safe interventions are urgently needed. Cannabidiol has some biological plausibility and may be an alternative to current medications for this patient group. Anecdotal reports and preliminary research suggest that cannabidiol may be safe and effective in managing SBPs in children with ID; however, well-designed studies are lacking to support its use. This pilot study aims to investigate the feasibility of conducting a randomized controlled trial of cannabidiol to reduce SBPs in children with ID.

5.13 A PILOT RANDOMIZED CONTROLLED TRIAL OF CANNABIDIOL TO REDUCE SEVERE BEHAVIORAL PROBLEMS IN CHILDREN AND ADOLESCENTS WITH INTELLECTUAL DISABILITY

Severe behavioral problems (SBPs) are a common contributor to morbidity and reduced quality of life in children with intellectual disability (ID). Medications commonly used for the treatment of SBPs in ID are associated with a high risk of side effects. Innovative and safe interventions are urgently needed. Cannabidiol has some biological plausibility and may be an alternative to current medications for this patient group. Anecdotal reports and preliminary research suggest that cannabidiol may be safe and effective in managing SBPs in children with ID; however, well-designed studies are lacking to support its use. This pilot study aims to investigate the feasibility of conducting a randomized controlled trial of cannabidiol to reduce SBPs in children with ID.

22.4 TRADING PLACES FOR A BETTER OUTCOME: A MOBILE SCHOOL-BASED MENTAL HEALTH CLINIC

Early identification and treatment of mental illness has been shown to improve health and academic performance. Attrition rates in clinics for children with behavioral problems range from 35 percent to 75 percent. In 2016, the University of Florida, College of Medicine, Jacksonville’s (UFJAX) Department of Psychiatry launched its School Psychiatry Program (UFSPP) in Duval County’s Pride Academy Schools (PAS). These schools service children with the most severe behavioral problems in the county. This presentation will describe the UFSPP, compare attendance and parent satisfaction data to outpatient child psychiatry clinics (OCPCs), and discuss efforts to address attrition.

3.64 PARENT-IDENTIFIED BARRIERS AND SOLUTIONS TO THEIR ENGAGEMENT AND RETENTION IN CHILD MENTAL HEALTH SERVICES

This presentation aims to examine factors influencing parents of children with severe behavioral problems engagement and retention in child and adolescent mental health services (CAMHs) and methods to improve their receptiveness to CAMHs. We hypothesize that parental engagement in CAMH will be correlated with: 1) attitudes toward mental health treatment (MHT); 2) ease of accessing CAMHs; and 3) past experiences with CAMHs.

Small 7p22.3 microdeletion: Case report of Snx8 haploinsufficiency and neurological findings

Some cases of chromosome 7p22.3 deletions have been reported, but the genotype-phenotype correlation is still uncertain. Neurodevelopmental delay and heart anomalies have been recorded as the most recurrent defects. We describe the clinical features of a four-year-old male child with a 139 kb deletion at 7p22.3 involving SNX8 gene, inherited from a mosaic mother. The same deletion is also present in the fetus on the ongoing third pregnancy of the couple with normal fetal ultrasound assessment.The proband was prenatally diagnosed with left kidney agenesis. He does not show any congenital heart disease, but mild intellectual disability, learning and language delay, and severe behavioral problems related to the hyperactive-impulsive and inattentive area. These clinical features are also evident in other 7p22 deletions cases involving the SNX8 gene, supporting the role of this gene in neurodevelopment. Conversely, the revision of all published cases with small 7p22 deletions and the absence of heart malformations in the present family confirm that this region is involved in heart development, anyway did not confirm the role of SNX8 in cardiac phenotypes, either due to the reduced penetrance or the involvement of other candidate genes.

Identifying Precursors to Severe Problem Behavior

Identifying Precursors to Severe Problem Behavior

Association Between Childhood Behavioral Problems and Insomnia Symptoms in Adulthood

Life-course determinants of insomnia, particularly the long-term association of childhood behavioral problems with insomnia later in life, are unknown. As childhood behaviors are measurable and potentially modifiable, understanding their associations with insomnia symptoms may provide novel insights into early intervention strategies to reduce the burden. To investigate the association between behavioral problems at 5, 10, and 16 years of age and self-reported insomnia symptoms at 42 years of age. This cohort study used data from the United Kingdom 1970 Birth Cohort Study, an ongoing large-scale follow-up study. Participants were followed up from birth (1970) to age 42 years (2012). Missing data were imputed via multiple imputation. Statistical analysis was performed from February 1 to July 15, 2019. Behavior measured at 5, 10, and 16 years of age using the Rutter Behavioral Scale (RBS). Children's behavior was classified as normal (≤80th percentile), moderate behavioral problems (>80th to ≤95th percentile), and severe behavioral problems (>95th percentile) based on their RBS score. Self-reported difficulties initiating or maintaining sleep (DIMS) were collected using a self-administered questionnaire at 42 years of age. Log-binomial logistic regression, adjusted for several potential confounders, was used to estimate the association of childhood behavioral problems with insomnia symptoms in adulthood. Sensitivity analyses were conducted to check robustness of the findings. Participants were followed up from a baseline age of 5 years (n = 8050; 3854 boys and 4196 girls), 10 years (n = 9090; 4365 boys and 4725 girls), or 16 years (n = 7653; 3575 boys and 4078 girls) until age 42 years. There was a 39% higher risk of DIMS (odds ratio [OR], 1.39; 95% CI, 1.04-1.84; P = .06 for trend) for participants with severe behavioral problems at 5 years of age compared with those with a normal RBS score. The odds of DIMS plus not feeling rested on waking (DIMS plus) in participants with severe behavioral problems at 5 years of age were 29% higher (odds ratio, 1.29; 95% CI, 0.97-1.70; P = .14 for trend) than participants with a normal RBS score, although this result was not statistically significant. Moderate and severe behavioral problems at 16 years of age were positively associated with DIMS and DIMS plus (moderate: OR, 1.28; 95% CI, 1.07-1.52; severe: OR, 1.67; 95% CI, 1.22-2.30; P < .001 for trend) and DIMS plus (moderate: OR, 1.32; 95% CI, 1.11-1.56; severe: OR, 1.47; 95% CI, 1.09-1.98; P < .001 for trend). Externalizing behavioral problems at 5 and 10 years of age were positively associated with insomnia symptoms at 42 years of age. This study is the first to show associations of early-life behavioral problems, particularly early- and middle-childhood externalizing problems, with insomnia symptoms in adulthood. These findings underline the importance of addressing insomnia from a life-course perspective and considering the benefits of early behavioral intervention to sleep health.

Participatory Peer Research in the Treatment of Young Adults With Mild Intellectual Disabilities and Severe Behavioral Problems.

This study provides an illustration of a research design complementary to randomized controlled trial to evaluate program effects, namely, participatory peer research (PPR). The PPR described in current study was carried out in a small sample (N = 10) of young adults with mild intellectual disabilities (MID) and severe behavioral problems. During the PPR intervention, control and feedback to individuals is restored by training them to become participant‐researchers, who collaborate in a small group of people with MID. Their research is aimed at the problems the young adults perceive and/or specific subjects of their interest. The study was designed as a multiple case study with an experimental and comparison group. Questionnaires and a semistructured interview were administered before and after the PPR project. Results of Reliable Change Index (RCI) analyses showed a decrease in self‐serving cognitive distortions in the PPR group, but not in the comparison group. These results indicate that PPR helps to compensate for a lack of adequate feedback and control, and in turn may decrease distorted thinking and thereby possibly later challenging behavior.

Dirençli Epilepside Düşük Glisemik İndeksli Diyet Tedavisi: Olgu Sunumu

Yüksek oranda yağ, yeterli miktarda protein ve düşük karbonhidrat içeren ve açlıkta olduğu gibi vücudu glukoz yerine başlıca yağlardan enerji sağlayacak şekilde yönlendiren ketojenik diyet, geçmişten günümüze ilaca dirençli epilepsi hastalarının tedavisinde ilk akla gelen tedavi seçeneğidir. İlk olarak 1920’li yılların başında ‘klasik ketojenik diyet’ ile başlayan geleneksel KD tedavisini, diyetin yeni etki mekanizmalarının keşfedilmesi ile birlikte 2000’li yılların başından itibaren ortaya çıkan ve daha az kısıtlama yapılan alternatif KD’ler izlemiştir. Alternatif diyetler çoğunlukla diyete uyumun azaldığı adölesan (12-18 yaş) dönemde tercih edilse de, ciddi davranış sorunları olan ve diyetten fayda görmesine rağmen diyete uyumun azalması nedeniyle nöbet kontrolü sağlanamayan daha küçük yaştaki çocuklarda da göz önünde bulundurulması gerekebilir. Bu alternatif KD’lerden birisi olan düşük glisemik indeks tedavisi (LGIT) kan glukoz düzeylerini minimal ve stabil düzeyde tutmayı amaçlar ve bu şekilde epileptik nöbetler kontrol altına alınır. LGIT, klasik KD’e oranla daha fazla karbonhidrat (enerjinin yaklaşık %10’u, günde 40-60 g/gün düşük glisemik indeksli karbonhidratlar) ve protein (enerjinin %25’i) alımına, dolayısı ile daha fazla besin tüketimine olanak sağlar. Bu olgu sunumunda, preadölesan dönemde olan ve hafif nöbet bulguları, şiddetli elektroansefalogram (EEG) bozukluğu ve davranış bozuklukları ile izlenen bir vakada, klasik KD uygulamasındaki zorluklar ve LGIT diyetine geçişin tedavinin etkinliği üzerindeki etkileri tartışılmıştır.