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PubMed1992

A content analysis of written behavior management programs.

A method is described for assessing the elements of individual behavior management programs. The content analysis, consisting of 24 items covering the general categories of behavior specification, objectives, program procedures, data collection, and quality assurance, was applied to 141 written behavior programs of two large institutions from different regions of the United States. These data can be utilized readily to establish a data base for program evaluation at both the individual and institutional levels. In addition, to provide a measure of validity, the items included in the content analysis were rated by experts in the treatment of severe behavior disorders. General strengths and weaknesses of the programs, and of the content analysis itself, are discussed in light of their implications for program implementation and evaluation.

Behavior Therapy↗
PubMed2000

[Psychological disorders and behavioral symptoms in dementia and differential diagnostic significance].

Dementia is one of the most common diseases in the elderly. Rapid and comprehensive diagnosis and appropriate treatment are imperatives. Over the course of the disease, psychiatric disturbances and behavioral abnormalities will frequently occur with the most variable of manifestations and forms. The burden on caregivers is immense. Patients usually respond well to a combination of milieu therapy and pharmacological management. The nature and the manifestation of the disorder can provide important clues for differential diagnosis.

Aged↗
PubMed1995

When and how does schizophrenia produce social deficits?

The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizophrenic patients are consequences of the illness, consequences of changes in the individuals predisposed to develop schizophrenia or are due to the adverse social conditions that lead to schizophrenia. The study focuses on the socioeconomic status at onset, on the performance of social roles in the early course of schizophrenia by taking age, gender and the individual level of social development into account. In a representative sample of 232 first episodes of schizophrenia age and type of onset.type and accumulation of symptoms and social functioning in the prodromal and the psychotic prephase and at first admission were assessed and analysed for their predictive power concerning social disability 2 years after first admission. In a case-control study expected and observed social functioning from onset until first admission were compared. The subsequent course was followed up prospectively in five cross sections until 2 years after first admission. In women the age at onset was significantly higher than in men, whereas symptomatology and type of onset showed no gender differences. In 73% of the sample the prodromal phase covered 5 years on average, and the psychotic prephase (until the maximum of positive symptoms) 1.1 years. Deficits in social functioning occurred predominantly during the prodromal and the psychotic prephase. The course over 14 years showed stable group trends in social and symptom measures. By the end of the prodromal phase it was possible to predict social disability 2 years after first admission with a correct classification of 81%. The main factor determining social outcome appeared to be the acquired social status during the prodromal phase of the disorder. The unfavourable early course in men was due mainly to their significantly lower age at onset. These results raise questions concerning an earlier therapeutic and rehabilitative intervention.

Adolescent↗
PubMed1994

Mental health problems in elderly people with and without Down's syndrome.

This article reports on age-specific findings of mental health problems among residents with Down's syndrome (DS) (n = 307) and without (non-DS) (n = 1274 in dutch group homes and institutes for people with mental retardation. Whereas a proportional increase of psychological problems was found for elderly DS persons with severe mental retardation, non-DS residents did not show such age-specific differences. High ratings of psychological problems for the elderly DS residents corresponded very well with the diagnosis of 'dementia' made by the physicians. Only for non-DS persons with severe mental retardation was a proportional decrease of challenging behaviour found with advanced age. Whereas psychological problems in elderly DS persons could be explained for the greater part of the diagnosis 'dementia', challenging behaviour--although also common in elderly DS--was shown to be a more independent phenomenon. With regard to psychiatric diagnosis, non-DS residents with mild retardation had six times as much a mental disorder, and non-DS residents with severe or profound mental retardation had up to 15 times as much, compared with their DS peers.

Adolescent↗
PubMed1991

[Psychopathological mechanisms of socially dangerous acts and the problem of responsibility].

The authors discuss the problems of forensic-psychiatric expert examination related to the responsibility of persons suffering from different mental disorders. In addition to the assessment of the clinical picture of a mental disease, it is necessary to take into consideration (as fully as possible) the genesis and character of the committed socially dangerous action (SDA). For this purpose it is recommended that the concept of the psychopathological mechanisms of SDA worded by the authors and their classification be made use of. The establishment in a mental patient of one of the distinguished mechanisms of SDA allows the differentiation of the intellectual and volitional signs of the judicial (psychological) criterion and scientific basing of the conclusion as to the patient's irresponsibility.

Crime↗
PubMed1998

Schizophrenic disorder and social functioning.

Social functioning is assessed according to 84 questioned subjects with schizophrenic disorder and their 84 key figures. Schizophrenic subjects showed significant dysfunction in all reviewed areas of behaviour and social roles. Key figures of all schizophrenic subjects most often showed a positive attitude in regard to the future of the schizophrenic members of their family. In relation to social functioning of the schizophrenic subject and the attitude of family key figures there is a statistically significant difference as well as a relationship. Results of assessment confirmed the impact of family life on social functioning of the schizophrenic patient and stresses the importance of active family support in rehabilitation programs.

Adult↗
PubMed1980

[Motivatron, behavior and behavior disturbances].

The presented models rather are of a didactical value. They are an attempt to present the complicated expressions of the behaviour disorders in a clear and simple form from the viewpoint of the motivation therory. It is clear that, as is the case with every scheme, they simplify the problems. However, it appears to us that the attempt of a synthesis almost always leads more or less to a schematisation in order to show the phenomena in a more generalised, clear form. An attempt has also been made to extract from the manifold data and theroies the "rational nuclei" and, departing from the phenemonological descriptions of the behaviour disorders, to find with their help a psychophysiological and pathopsychophysiological explanation.

Conditioning, Psychological↗
PubMed2001

Self-injurious behaviour before and after deinstitutionalization.

The deinstitutionalization movement is presently spreading in Europe. Studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) have been inconclusive. The present paper focuses on people without self-injurious behaviour (SIB) who developed SIB after deinstitutionalization. The present authors studied individual and environmental characteristics before and after deinstitutionalization to look for factors associated with the development of SIB which could also be possible intervention points for preventive action. All those individuals in an institution for people with ID who did not have SIB before deinstitutionalization were included in the present study. The individuals who developed SIB after deinstitutionalization (n = 15) formed the study group (group A) and those who did not (n = 53) comprised the control group (group B). The population was examined both before and after deinstitutionalization. As far as possible, the same methods were used at both occasions. The covariates were both individual (e.g. mental health, behaviour disturbances and behaviour deficits) and environmental (e.g. caretaker education, caretaker:patient ratio, housing and leisure activities). Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults, which was filled in by the caretakers. In 1987, the people in group A who acquired SIB had lower developmental quotients, used wheelchairs more often and had trouble with moving around without help. They also had a greater frequency of epileptic seizures, and hearing and communication impairment. In 1995, there were only minor environmental differences between groups A and B. There were significantly more individuals involved in the rotation period and more unskilled caretakers working with the people in group A than group B. The present authors found no differences between the two groups on variables such as global mental health and behaviour disturbances, or in the use of neuroleptics before or after deinstitutionalization. Groups A and B did not show differences in behaviour disturbances or psychiatric disorders in 1987. In both 1987 and 1995, there were no differences between groups A and B on variables such as accommodation, caretaker:patient ratio, the number of caretakers involved in direct care, the caretakers' education, or the time spent in structured activities before and after deinstitutionalization. The individual characteristics indicating that a person may acquire SIB are behaviour deficits which are suggestive of central nervous system dysfunction or damage, even if the results are inconclusive. The development of SIB may also be facilitated by communication deficits or by reinforcement of a incidentally occurring SIB if the staff includes many unskilled caretakers in the rotation period.

Adolescent↗
PubMed1989

Behavioral diagnostics.

The contemporary behavior analyst, to operate ethically and effectively, must be aware of many more factors affecting behavior than simple consequences. Although the literature demonstrating the effectiveness of active behavior management is impressive, a compelling argument can be made that a great number of behavior problem seen in individuals with developmental disabilities may be attributable to factors other than consequences. Our experience has been more often than not that physiological, organic, medication, or situational variables are the actual culprits in maladaptive behavior. Individuals with severe or profound retardation may respond to aversive features of their environment by displaying noncompliance, tantrums, aggression, or self-injurious behavior. These antecedents can affect their behavior just as powerfully as can the consequences of their behavior. Behavior analysts must become sensitive to these potential factors and be prepared to employ behavioral diagnostic strategies in the search for the causes of maladaptive behavior. Finally, they must be prepared to design rather unconventional passive behavior management treatment programs involving the manipulation of the antecedent environment. In the case of Carrie, from the example at the beginning of this paper, the analysis yielded the hypothesis that her face scratching was a reaction to sinus blockage caused by seasonal allergies. Her treatment involved daily dosages of antihistamines administered by our nurses and subsequent elimination of the scratching. Tom was found to be suffering from "wheelchair fatigue." When he was allowed to recline on other surfaces (e.g., bean bag chair, mat, bolster) on a regular basis, he did not attempt any form of self-injury. Melissa was found to have a severe case of Pre Menstrual Syndrome as well as seizure disorder, and was treated with the appropriate medications. Her headbanging was reduced to a few minor incidents per month. Walter's tantrums on closer inspection seemed part of a chain of behavior leading to seizure-like attacks. Preliminary evidence suggests that when he is treated with phenobarbital the tantrums and aggression disappear. And finally, Debbie was found to be very sensitive to a variety of discomforting events. She would cry, sob, and scream when she was wet, thirsty, hungry, and tired. Changing her regularly, offering her water every hour and extra snacks in the morning as well as short naps in the early afternoon eliminated the crying and sobbing. She now participates with the other clients and seems to enjoy the house activities.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2004

The psychopharmacologic treatment of violent youth.

Aggressive violence has been described as the greatest problem and the most frequent reason for referrals in child and adolescent psychiatry. In this country we have only partially emerged from an epidemic of violence that was really an epidemic of youth violence. Thus it is hardly surprising that psychiatrists are being asked more and more frequently whether psychiatric medications might help to diminish the toll from this behavioral plague. Medications are useful and appropriate for only a small minority of the people who commit serious violence. Even when they are indicated, they can never be the sole treatment modality, but should be supplemented by psychological and social therapies. When the violence is a byproduct or symptom of an underlying mental illness, treating that illness is generally the most effective method of preventing future violence on a long-term basis. However, most violence is not committed by those who are mentally ill, and most of the mentally ill never commit a serious act of violence. That is why many attempts have been made to discover whether there are drugs that diminish the symptom, violence, even when there is no underlying mental illness for which drugs would normally be prescribed. In fact there are several, and their indications and use are reviewed here. Different principles govern the acute short-term emergency treatment of a violent crisis and the long-term treatment of those who are chronically and repetitively violent, and these differences are also summarized here.

Adolescent↗
PubMed1987

Motor, behavioral and pharmacologic findings in Tourette's syndrome.

We studied 112 patients with Tourette's syndrome (TS); the male-to-female ratio was 3.8, the mean age of onset was 7.3 years, and the average duration of symptoms prior to the initial evaluation was 15.2 years. Seventy-nine percent of the patients had at least one family member with motor or vocal tics, and an additional 10 percent had a family member with marked obsessive-compulsive behavior. Simple motor tics occurred as the presenting symptom in about one-third of patients; one-third had multiple motor tics at the onset, and another third started with vocal tics. During the course of the illness all patients developed multifocal motor tics and 86 percent had vocal tics. Verbal and mental coprolalia was present in 44 percent of the patients. Copropraxia was seen in 19 percent of patients, and both coprolalia and copropraxia were more frequent among the males than expected. Attentional deficit disorder was diagnosed in 36 percent of the patients and 32 percent had obsessive-compulsive personality. Sleep disturbances were reported by 62 percent of the patients and polysomnographs in 34 patients showed motor and vocal tics during all stage of sleep, sleep apnea, abnormal arousal pattern, and other sleep disturbances. Patients with mild symptoms improved with clonidine or clonazepam, but those with more advanced disorder required fluphenazine, pimozide, haloperidol or tetrabenazine.

Adolescent↗
PubMed1997

Persisting childish behavior after bilateral thalamic infarcts.

We report a case with bilateral paramedian thalamic infarcts. The patient showed a dramatic personality change characterized by childish behavior and euphoria; which remained unchanged for 2 years after the onset. 'Vorbeireden' characterized by approximate answers was also observed. Anterograde amnesia had quite improved after 2 years, while retrograde amnesia for 1 year prior to the stroke onset and vertical gaze palsy remained unchanged. An MRI scan demonstrated bilateral medial thalamic and right midbrain infarcts without other lesions in the brain. A position emission tomography study showed that cerebral metabolic rate for glucose was markedly decreased in both thalami and in the cerebellum, and only slightly decreased in the parietal and occipital cortical regions. Cerebral metabolic rates of glucose in the frontal and temporal cortices were within normal range. The paramedian thalamic lesions per se may be responsible for the patient's personality change, 'Vorbeireden', and amnesia.

Adult↗
PubMed2006

Psychosocial interventions for disruptive symptoms of dementia.

An estimated 6% to 8% of the adult population age 65 and older and more than 30% of those age 85 and older are affected by a dementing disorder. The annual direct and indirect cost of caring for the 4.5 million people with Alzheimer's disease in the United States is estimated to be at least $100 billion. By 2030, when the entire Baby Boomer generation is age 65 and older, the increased number of people with Alzheimer's disease could exceed the ability to absorb the added cost. Both professional and familial caregivers should be familiar with the treatment interventions that are most effective in reducing the disruptive behavioral and psychological symptoms of dementia. This article discusses the various kinds of dementia, their associated symptoms, and the psychosocial treatment options that have been found to be effective in alleviating the effects of the disease on both people with dementia and their caregivers. Psychosocial strategies can be divided into four major subgroups: communication techniques, behavioral strategies, environmental modifications, and caregiver education. The ultimate goal is to optimize functioning of people with dementia and minimize caregiver strain.

Aged↗
PubMed1997

Secular change in psychosocial risks: the case of teenage motherhood.

BACKGROUND: Many social and demographic correlates of psychiatric disorder have shown marked secular changes in recent decades. This study was designed to explore some of the implications of these trends, focusing on the illustrative case of teenage motherhood. METHOD: Prospective data from two British birth cohort studies (the 1946 and 1958 cohorts) were used to examine the social, educational and behavioural precursors of teenage versus older age at motherhood, and the implications of teenage motherhood for women's later marital and social circumstances and risks of psychiatric morbidity, in samples born 12 years apart. RESULTS: Educational and social disadvantage were associated with similarly increased risks of teenage motherhood in both cohorts, but the findings suggested an additional association with teacher-rated adolescent conduct problems in the more recent sample. Rates of teacher-rated emotional problems were not elevated among teenage mothers in either cohort. In adult life, teenage motherhood was associated with a range of adverse social outcomes, including partnership breakdowns, large family size, and poorer housing conditions. Relative risks of these adult adversities were similar for teenage mothers in the two cohorts, but absolute levels of adversity were higher in the more recent sample, reflecting general secular changes in many of the indicators involved. In the later, but not the earlier, cohort, teenage motherhood was also associated with increased risks for psychiatric morbidity in adulthood. CONCLUSIONS: The findings underline the importance of taking account of secular trends in examining the impact of psychosocial risks.

Adolescent↗
PubMed1999

The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review.

OBJECTIVE: This paper provides a systematic review of research findings published between 1989 and 1998 concerning non-pharmacological strategies to alleviate behavioural disturbances in elderly persons with dementia. METHOD: Data collection strategies included computer literature searches, manual searches of selected journals and checks of references listed in previous reviews. To warrant inclusion, studies were required to include some measure of behaviour before and after the introduction of an intervention. Papers were appraised in the following domains: design, sampling technique, setting, behaviours studied, measurement tools, data collection methods, type of interventions and feasibility. An overall validity rating was assigned to each article using predetermined rules. RESULTS: Forty-three studies met criteria for inclusion including five randomised controlled trials. Validity ratings were as follows: one strong, 15 moderate, and 27 weak. Areas of scientific weakness included small numbers of subjects, inadequate descriptions of study participants, imprecise data collection methods, high attrition rates and insufficient statistical analysis. Despite this, there is evidence to support the efficacy of activity programs, music, behaviour therapy, light therapy, carer education and changes to the physical environment. The evidence in favour of multidisciplinary teams, massage and aromatherapy is inconclusive. CONCLUSIONS: It was easier to interpret the results of rigorously designed studies that focused on a single behaviour or single intervention tailored to the needs of individuals and carers. Future studies should seek to replicate the findings outlined here, improving methodologies where necessary and including outcome measures that encompass the interests of people with dementia, family caregivers and health professionals.

Aged↗
PubMed1999

Etiology of alcohol use among Hispanic adolescents: sex-specific effects of social influences to drink and problem behaviors.

BACKGROUND: Hispanic adolescents seem to be at greater risk for alcohol use; a greater understanding of the factors that predict alcohol use among Hispanic youth is needed. Social influences to drink and other problem behaviors often predict adolescent alcohol use. However, most past research has concentrated on samples of predominantly white adolescents residing in suburban areas. OBJECTIVES: To determine which demographic factors, social influences, and problem behaviors are associated with alcohol use among Hispanic adolescents and to eludicate the difference in the origins of alcohol use depending on sex. DESIGN: Cross-sectional study. SETTING: Middle schools in New York City. PARTICIPANTS: This study focuses on 1410 adolescents in grade 7 from inner-city schools who identified themselves as Hispanic at the baseline assessment of an investigation of alcohol and other drug use. MAIN OUTCOME MEASURES: Alcohol initiation, alcohol consumption, and future drinking. RESULTS: The findings showed that social influences to drink and reported problem behaviors were associated with alcohol use across and within sex groups. In particular, friends' drinking was related to alcohol initiation, consumption, and plans to drink in the future across sexes and within both sex groups. Other predictors (mother's drinking, siblings' drinking, ease of obtaining alcohol, deviance, cigarette smoking, and marijuana use) exhibited sex-specific effects. CONCLUSION: These findings lend support to teaching social resistance skills to improve Hispanic adolescents' ability to resist social influences to drink and use other drugs.

Adolescent↗