Withdrawal Design Research Articles

Efektivitas Token Ekonomi dalam Menurunkan Agresifitas pada Remaja

Aggressive behavior is an attitude that is often shown by teenagers. Adolescence is also identified with the inability of adolescents to control their emotions. The purpose of this study was to determine the effectiveness of the token economy to reduce aggressiveness in adolescents. The method used is qualitative-experimental, namely pre-experimental. Data collection was carried out using a behavioral checklist and using an A-B withdrawal design. The research subjects were 13-year-old girls from strict parent families. The results showed that there was a decrease in aggressiveness at an average anger of 3.7 to 0.4. So that the economic token is effective for reducing aggressiveness in adolescents

Improving Behavior in a Self-Contained Elementary Classroom for Students With Emotional or Behavioral Disorders: A Study of CW-FIT

Class-wide Function-related Intervention Teams (CW-FIT) is a classroom management intervention in which teachers incorporate positive behavior support (PBS) principles by teaching specific classroom expectations and providing feedback on student behavior as part of an interdependent group contingency. Interventions like CW-FIT may be helpful for students with emotional or behavioral disorders (EBD), as such students often struggle to succeed in school. In the present replication study, researchers examined the effects of CW-FIT in a self-contained elementary EBD classroom. One teacher and her five students with EBD participated. Researchers used an A-B-A-B withdrawal design with maintenance probes to examine changes in students’ on-task behavior, as well as teacher praise and reprimand rates. Results revealed the teacher was able to implement CW-FIT with fidelity with corresponding increases in student on-task behavior and teacher praise, though there was little effect on teacher reprimands. The teacher and the students found CW-FIT to be socially valid. Results suggest CW-FIT can be an effective classroom management intervention in self-contained elementary EBD classrooms.

Behavior-specific praise: Enhancing on-task behavior in a rural elementary school

Behavior-specific praise (BSP) is a low-intensity strategy used to reinforce positive student behaviors in school settings. BSP is currently a potentially evidence-based practice, with more studies with three or more participants needed to contribute to the literature base. This study investigated the impact of teacher-delivered BSP on student on-task behavior in an inclusive second grade classroom taught by a general and special education coteacher dyad in a rural Southeast school. Using an A-B-A-B withdrawal design, we observed the on-task behavior of four students with emotional and/or behavioral disorders (EBD) when the coteaching pair increased their rates of BSP after a brief training. All four students increased on-task behavior during BSP intervention conditions. Social validity questionnaires identified a positive impression from three out of four students and both teachers about the implementation of BSP in the classroom. Limitations and future directions are discussed.

Overview of Single-Subject Design in Special Education Studies

In recent years, there has been an increase in the use of single-subject design in special education research. This paper provides an insightful overview of the application of single-subject design within special education studies. The paper delves into an exploration of the fundamental concepts underlying single-subject design, its historical origins, and the wide range of purposes it serves. Furthermore, an examination of the strengths and weaknesses inherent to single-subject design is undertaken. Finally, an evaluation of withdrawal design, multiple baseline design, and alternating treatment design and their special education research application are offered. In this evaluation, the researcher specifically examines how these designs can be applied in special education research contexts. By exploring these variations, this paper provides insights into the diverse ways single-subject design can be applied to address the unique research needs and challenges in special education.

Supporting the Conversational Behavior of Adolescents with Autism Spectrum Disorders with Self-Monitoring and a Video-Based Supplement.

Individuals with autism spectrum disorders (ASD) might demonstrate impairments in initiating and sustaining a conversation and experience conversational challenges such as question-asking and turn-taking. Conversational skills are pivotal for the social functioning of adolescents with ASD. The current investigation aimed to extend the available information on interventions addressing the conversational needs of adolescents with ASD. The research questions were: (a) What is the effect of self-monitoring, supplemented by a video-based model on the conversational skills of adolescent students with ASD? and (b) What is the acceptability of the intervention among the participating adolescents with ASD?. Appropriate conversational behavior of three students with ASD (aged 16-18 years) was assessed using a withdrawal design, during 10-min conversation sessions. Appropriate conversational behavior was defined as a sequence of a turn-taking response (i.e., waiting quietly until the speaker finished talking), followed by a verbal utterance which included (a) making a statement or responding on topic, and/or (b) asking a contextually appropriate "wh"- question. The independent variable consisted of a primary self-monitoring procedure and a daily video-based supplement. Treatment fidelity and treatment acceptability were also assessed. The conversational behavior of all participants consistently improved under the self-monitoring intervention with the video-based supplement. Self-monitoring with a video-based supplement can effectively support the conversational behavior in adolescents with ASD. This information can guide the evaluation and planning of appropriate interventions designed to improve limited conversational behaviors of adolescents with ASD.

Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson’s disease. A single-subject design

Purpose Parkinson’s disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression. Recommendations to incorporate exercise at moderate to high intensities for this population has been established but there is limited knowledge about its impact on clinical based outcomes. The purpose of this research is to investigate the effectiveness of a 6-week intensity-driven walking program on clinical-based outcomes in individuals with PD. Materials/Methods Five individuals with PD were recruited for this single-subject withdrawal design (A-B-A-B) study. 6-minute walk performance and other core neurological measures of gait were collected. Intervention phases incorporated a 30-minute individualized intensity-driven treadmill walking program practiced at 65% or more of ones maximum heart rate. Increased treadmill speed, incline, and resistance were manipulated to reach the target heart rate zone. Results 6-minute walk test within condition visual analysis demonstrated a therapeutic change during intervention phases and a countertherapeutic change during withdraw periods for all 5 individuals. An abrupt therapeutic effect was demonstrated for all individuals between conditions with the percent of nonoverlapping data ranging from 70-90%. Band method analysis revealed a range of 9-19 sessions two standard deviations above baseline mean performances for all individuals. Conclusion To achieve sufficient walking performance, gait practiced at higher intensity levels may provide the optimal solution as an adjunct to standard care for individuals with PD who want to improve their walking.

Supporting implementation of culturally responsive teaching in a therapeutic setting.

This brief report describes findings from a single case withdrawal design study which explored the impact of training and emailed video prompts to promote a teacher's implementation of a culturally responsive teaching plan in a therapeutic school. Data collectors gathered implementation data as well as observed students' academic engagement and disruptive behavior. The teacher also provided self-report data regarding student outcomes. Results indicated that, overall, training and emailed video prompts demonstrated improvement in the teacher's implementation of the classroom plan as well as student behavior. However, the improvement in dependent variables was more discernible from the first Phase A to Phase B than the second A to B phase change. To build upon these results, we describe that additional research is needed to generalize findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Clinical trial designs to assess treatment effects on glomerular filtration rate decline

Glomerular filtration rate (GFR) decline is used as surrogate endpoint for kidney failure. Interventions that reduce chronic kidney disease (CKD) progression often exert acute GFR reductions which differ from their long-term benefits and complicate the estimation of long-term benefit. Here, we assessed the utility of two alternative trial designs (wash-out design and active run-in randomized withdrawal design) that attempt to exclude the impact of acute effects. Post-hoc analyses of two clinical trials that characterized the effect of an intervention with acute reductions in GFR were conducted. The two trials included a wash-out period (EMPAREG-Outcome testing empagliflozin vs placebo) or an active run-in period with a randomized withdrawal (SONAR testing atrasentan vs placebo). We compared the drug effect on GFR decline calculated from the first on-treatment visit to the end-of-treatment (chronic effect in a standard randomized trial design) with GFR change calculated from randomization to end-of-wash-out, or GFR change from treatment specific baseline GFR values (GFR at start-of-run-in for placebo and end-of-run-in for atrasentan) until end-of-treatment. The effect of empagliflozin versus placebo on chronic GFR slope was 1.72 (95% confidence interval 1.49-1.94) mL/min/1.73m2 /year, similar to total GFR decline from baseline to the end of wash-out period using a linear mixed model 1.64 (1.44-1.85) mL/min/1.73m2 /year). The effect of atrasentan versus placebo on chronic GFR slope was 0.72 (0.32-1.11) mL/min/1.73m2 /year, similar to total slope from a single slope model when estimated from treatment specific baseline GFR values 0.77 (0.39-1.14) mL/min/1.73m2 /year). Statistical power of the two designs outperformed the standard randomized design. Thus, wash-out and active-run-in randomized-withdrawal trial designs are appropriate models to compute treatment effects on GFR decline.

Peer-Mediated Interventions to Enhance Conversation Skills of Young Adults with Intellectual and Developmental Disabilities on a University Campus

Young adults with intellectual and developmental disabilities (IDD) on college campuses are vulnerable to exclusion and a lack of social participation. However, peers can provide meaningful supports to young adults with IDD in the area of social/communication skills. The purpose of this study was to enhance the conversation skills of four young adults with IDD (ages 22–23) during their regular lunch breaks on a university campus. The dependent variable was percent of conversational engagement during 10-min audio recorded sessions as measured using partial interval recording procedures. Typically developing peers served as peer coaches and provided structured or natural supports. Experiment 1 used an alternating treatments design to compare the effects of peer coaching alone vs. peer coaching + goal setting with two adjacent baseline conditions and a final student-choice condition. Results for Experiment 1 indicated peer coaching alone and the additive effects of goal setting was more effective than natural supports only. Experiment 2 used a withdrawal design to compare the effects of young adults with IDD speaking with fellow classmates with disabilities vs. peers without disabilities. Participants in Experiment 2 demonstrated higher levels of conversational engagement when speaking with peers without disabilities in a natural manner. Social validity of the different peer-mediated interventions was overall high for all participant types as reported on questionnaires and exit interviews. We provide implications for practice and suggestions for future research related to peer-mediated interventions for young adults with IDD on college and university campuses.

Race-Conscious Teacher Coaching: Disrupting Implicit Bias and Improving Teachers’ Relationships with Black Students

ABSTRACT Racial discipline disproportionality is a persistent issue in schools with Black students experiencing exclusionary discipline two to three times more than their White peers, and Black males more likely to be diagnosed with an emotional and behavioral disorder. Interventions that target malleable root causes of disproportionality and have an explicit racial bias component may disrupt these processes. The study took place in an alternative school setting across two classrooms with White, fifth- and sixth-grade teachers (n = 2) and their Black students (n = 6). A single-case, withdrawal design (A-B-A-B) examined the impact of a semi-structured teacher coaching intervention on disrupting biases, improving classroom management and cultural competency, and ultimately improving student-teacher relationships. The coaching included Mindful STOP as a self-regulation strategy, the Mindful Reflection Protocol to discuss behaviors, and performance feedback, all focusing on outcomes related to student-teacher relationships and discipline. During intervention phases, Teacher 1 showed improvements in positive communication while keeping negative communication low. Teacher 2 showed smaller, more variable improvements. Teachers and students in both classrooms reported improvements in their relationships based on pre/post rating scales. Teacher-reported discipline outcomes were variable. These findings may provide concrete strategies for supporting the development of equitable discipline practices for Black students. Future studies will explore modifications to the current coaching package.

Adding to the Evidence Base: Effects of I-Connect in a Secondary Special Education Rural Classroom

The purpose of this study was to examine the effects of a technology-based self-monitoring application, I-Connect, to enhance the on-task behavior of five secondary students (ages 15–16) with autism spectrum disorder, intellectual disability, and specific learning disability during Biology instruction in a rural special education classroom. We used an A-B-A-B withdrawal design with a generalization condition. The primary dependent variable was percent of intervals with on-task behavior as measured by momentary time sampling procedures. Results indicated overall higher levels of on-task behavior for all students when using I-Connect to monitor their behavior. However, there were also high percentages of overlapping data, and student satisfaction with the application was relatively low. Students used I-Connect in an employability seminar offered at their school as a means to generalize to a different setting. We provide implications for practice in rural settings and suggestions for future research related to I-Connect. We also provide recommendations for enhancing the social validity of technology-based self-monitoring for secondary students with disabilities.

Increasing Reciprocal Social Interactions Between Children Who Use Augmentative and Alternative Communication and Peers Using a Collaborative Learning Framework.

Children with complex communication needs who rely on augmentative and alternative communication (AAC) strategies to express themselves face significant difficulties interaction with peers. This study sought to design, implement, and evaluate a collaborative photography intervention designed to increase reciprocal social interaction between children who use AAC and their same-age peers. A single-subject, withdrawal design (ABAB) was used to explore the functional relationship between engagement in a collaborative photography intervention and the frequency of reciprocal social interactions between children who use AAC and their same-age peers. Partial-interval time sampling was used to code the number of reciprocal social interactions across four dyads. Increased frequencies of reciprocal social interactions were observed in intervention phases across all four dyads. Very large levels of effect and 100% nonoverlapping data were noted for Dyads 1 and 4. Moderate levels of effect and 70% of nonoverlapping data were noted for Dyads 2 and 3. Collaborative learning frameworks may be used to increase reciprocal social interactions between children who use AAC and their peers. Speech-language pathologists should consider utilizing collaborative learning elements in activities with children who use AAC. Future research is needed to further explore collaborative learning frameworks for interventions for children who use AAC. https://doi.org/10.23641/asha.25464064.

Effects of the Good Behaviour Game on the Behaviour of Students with Mild Intellectual Disabilities in Physical Education Settings

ABSTRACT The Good Behaviour Game (GBG) is an interdependent group contingency intervention, previously shown to be effective in managing students’ behaviour across several studies. An ABAB withdrawal design was implemented to examine the effects of the GBG on the engagement and disruptive behaviours of 12 students diagnosed principally with a mild intellectual disability (Mage = 7.83 ± 0.83 years) enrolled in two self-contained physical education classes. The first phase of the intervention was carried out from November 27th until Janvier 25th and the second phase took place from April 2nd to May 10th. Video recordings of all sessions were directly observed and analysed using a code unit grid. The collected data were subjected to inferential statistical analysis. Results showed a significant increase in engagement and a decrease in disruptive behaviours during the B1 conditions compared to the baseline A1 for both class ‘A’ and ‘B’ (p < 0.001). Similarly, there was a significant increase in engagement and a decrease in disruptive behaviours during the B2 conditions compared to both the A2 and A1 baselines (p < 0.001). Overall, this study demonstrates the effectiveness of the GBG as an intervention for promoting engagement and reducing disruptive behaviours when implemented in physical education settings with students diagnosed with mild intellectual disabilities.

A comparison of recurrence rates after discontinuation of second-generation antipsychotic long-acting injectable versus corresponding oral antipsychotic in the maintenance treatment of bipolar disorder: A systematic review

It has been previously reported that among patients with schizophrenia that long-acting injectable (LAI) antipsychotic formulations can delay time to relapse longer when compared to their oral equivalents when patients discontinue therapy. Unanswered is whether this same pattern would be observed for patients with bipolar disorder receiving maintenance treatment. A systematic review was undertaken to identify relevant studies of LAI antipsychotics in maintenance treatment of bipolar disorder, employing a placebo-controlled randomized withdrawal design, and where equivalent studies using the corresponding oral formulation were also available. We found five studies [one aripiprazole monohydrate once monthly (AOM) study, one oral aripiprazole (OARI) study, two 2 weeks risperidone-LAI (RIS-LAI) studies, and one oral paliperidone (OPAL) study]. Numerically lower recurrence rates at 2, 4, 6, 8, 12, 16, 20, and 26 weeks were observed when AOM was discontinued when compared with discontinuation from OARI. Numerically lower recurrence rates at 2, 4, 6, 8, and 16 weeks were observed when RIS-LAI was discontinued when compared with discontinuation from OPAL. These results can be interpreted as a substantial delay in time to recurrence with a LAI antipsychotics formulation compared to the oral equivalent when medication is discontinued in patients with mania who had been stabilized on LAI antipsychotics or corresponding oral antipsychotics.

Effects of cholinesterase inhibition on attention and working memory in Lewy body dementias.

Cholinesterase inhibitors are frequently used to treat cognitive symptoms in Lewy body dementias (Parkinson's disease dementia and dementia with Lewy bodies). However, the selectivity of their effects remains unclear. In a novel rivastigmine withdrawal design, Parkinson's disease dementia and dementia with Lewy bodies patients were tested twice: once when taking rivastigmine as usual and once when they had missed one dose. In each session, they performed a suite of tasks (sustained attention, simple short-term recall, distractor resistance and manipulating the focus of attention) that allowed us to investigate the cognitive mechanisms through which rivastigmine affects attentional control. Consistent with previous literature, rivastigmine withdrawal significantly impaired attentional efficacy (quicker response latencies without a change in accuracy). However, it had no effects on cognitive control as assessed by the ability to withhold a response (inhibitory control). Worse short-term memory performance was also observed when patients were OFF rivastigmine, but these effects were delay and load independent, likely due to impaired visual attention. In contrast to previous studies that have examined the effects of dopamine withdrawal, cognitively complex tasks requiring control over the contents of working memory (ignoring, updating or shifting the focus of attention) were not significantly impaired by rivastigmine withdrawal. Cumulatively, these data support that the conclusion that cholinesterase inhibition has relatively specific and circumscribed-rather than global-effects on attention that may also affect performance on simple short-term memory tasks, but not when cognitive control over working memory is required. The results also indicate that the withdrawal of a single dose of rivastigmine is sufficient to reveal these impairments, demonstrating that cholinergic withdrawal can be an informative clinical as well as an investigative tool.

Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study

AbstractBackgroundPsychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive‐behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities.MethodsWe used a single‐case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini‐Maslow Assessment of Needs Scale‐Learning Disabilities), were used to assess the effectiveness of treatment.FindingsResults show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow‐up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant.ConclusionsThis SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.

Letter in reply: aletter to the editor commenting on the recent publication by AY Avidan and CA Kushida.

Letter in reply: aletter to the editor commenting on the recent publication by AY Avidan and CA Kushida.

Single-Case Experimental Design in Rehabilitation: Basic Concepts, Advantages, and Challenges.

Single-case experimental design is a family of experimental methods that can be used to examine the efficacy of interventions by testing a small number of patients or cases. This article provides an overview of single-case experimental design research for use in rehabilitation as another option along with traditional group-based research when studying rare cases and rehabilitation interventions of unknown efficacy. Basic concepts related to single-case experimental design and the characteristics of common subtypes ( N-of-1 randomized controlled trial, withdrawal design, multiple-baseline design, multiple-treatment design, changing criterion/intensity design, and alternating treatment design) are introduced. The advantages and disadvantages of each subtype are discussed along with challenges in data analysis and interpretation. Criteria and caveats for interpreting single-case experimental design results and their use in evidence-based practice decisions are discussed. Recommendations are provided for appraising single-case experimental design articles as well as using single-case experimental design principles to improve real-world clinical evaluation.

Effects of Tier 1 Class-Wide Function-Related Intervention Teams (CW-FIT) on On-task Group Behavior in a Preschool Classroom.

Disruptive behaviors such as elopement, calling-out, and aggression are often a major barrier to instruction in preschool classrooms. One widely used class-wide behavior management system is Class-Wide Function-Related Intervention Teams (CW-FIT). To date, we could only locate two studies on CW-FIT used in preschool settings which found a therapeutic change in on-task behavior as well rates of teacher praise, teacher reprimands, student socials skills, and student problem behaviors. The current study used a withdrawal design to also evaluate the effectiveness of Tier 1 CW-FIT on on-task student behavior and teacher praise and reprimand behavior in a preschool setting during both large and small group activities. Results suggested that the implementation of the Tier 1 components of CW-FIT increased on-task group behavior in both settings. Results for rates of teacher's praise and reprimand statements were variable.

Serving a Brief-Contact Cognitive Behavior Therapy Intervention in Youth Tennis Using a Single-Case Design

Brief cognitive behavior therapy is planned brief therapy designed to influence a specific target behavior (e.g., sport performance) with the lowest investment of cost and time. We report a brief cognitive behavior therapy intervention delivered to improve serve performance in county-level youth tennis players (three male and one female; Mage = 14.90 years). Following an assessment of athlete needs, we implemented a brief-contact intervention involving diaphragmatic breathing. The intervention was delivered across two “structured” sessions, with the athletes having access to the sport psychologist between sessions as required. To assess the effectiveness of the intervention, we implemented a single-case withdrawal design. Results indicated that the intervention had a positive effect on performance, with athletes’ first-serve percentage increasing significantly (3.91%, p &lt; .05). Results also indicated that a minimum preperformance-routine time (routine &gt; 2 s) might be required for effective performance outcomes. Finally, we offer reflections on the delivery and implementation of a single-case design, while navigating avenues of professional development.