INDIVIDUALIZED TEACHING WITH THERAPEUTIC AIMS: A METHODOLOGICAL STUDY.
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Comorbidity, time to recovery, rate of chronicity, and probability of recurrence following recovery were studied in 51 children diagnosed with attention deficit disorder, conduct disorder, and oppositional defiant disorder. Thirty-three percent of the children had two of the above diagnoses, and one child had all three diagnoses. The mean duration of attention deficit disorder was 8 years up to the time of the interview; the mean duration of oppositional defiant disorder was 4.5 years, and the mean duration of conduct disorder was 3 years. Life-table estimates showed that 14% of the children would not have recovered 15 years after the onset of their disorder. Rates of recurrence were high following recovery from each of these disorders.
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This study examined factors related to mental illness in children and adolescents. A survey of all 362 files of child and adolescent patients discharged from a single residential treatment facility in 1961-1962, 1971-1972, and 1978 revealed several major diagnostic trends. The proportion of cases diagnosed as schizophrenic decreased by one-third, those diagnosed as neurotic increased over ten-fold, and significant increases occurred in the proportion of children diagnosed as autistic, personality disorder, and behavior disorder of childhood and adolescence. There was a decrease in cases between 6 and 12 years of age and a significant increase in 13- to 18-year-olds. The relative importance of symptoms appeared to be interpreted differently at various times. Significant changes were also found In treatment length, in medications used, and in a number of factors related to the characteristics of the family.
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OBJECTIVE: This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. METHODOLOGY: A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. RESULTS: Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. CONCLUSION: The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.
Disruptive behaviors are often exhibited by children with severe disabilities during difficult teaching tasks. Because learning verbal communication can be a difficult task for nonverbal children with autism, disruptive behaviors are common during such interventions. The purpose of this experiment was to assess whether the incorporation of parameters of natural language interactions and motivational techniques might reduce disruptive behavior during language teaching tasks. Within a repeated reversals design with order of conditions and number of sessions varied within and across children, treatment was conducted for two language teaching conditions. During one condition trials were presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. The other condition incorporated parameters of natural language interactions and motivational techniques, such that stimulus items were functional and varied; natural reinforcers were employed; communicative attempts were reinforced; and trials were conducted within a natural interchange. Results showed that greater improvements in responding and considerably less (often negligible) disruptive behavior occurred during the natural language teaching conditions. Results are discussed with respect to their implications for improving language interventions, and with respect to reducing disruptive behavior without the need for specialized or severe interventions focused specifically on the disruptive behavior.
Two single-subject experiments were conducted with students in special preschool classes. In Experiment I, the subject's disruptive, appropriate, and inappropriate play behaviors were measured as a function of three independent variables: reinforcement, a typical timeout procedure, and regularly paced teacher instructions. In an ABA reversal within a multiple baseline across two teachers, all three independent variables comprised the A conditions and procedural timeout was omitted in B. Experiment II examined a second subject's appropriate and inappropriate eating as a function of the same three variables. Two teachers conducted baseline and paced instruction-plus-reinforcement conditions in multiple baseline across teachers. Subsequently, one teacher performed a series of reversals and replications with various combinations of a typical timeout procedure and reinforcement mixed with paced instructions. The results of both experiments suggest that timeout did not produce response decrement in a punishment paradigm, but rather produced response increment in a negative reinforcement paradigm. These results prevailed, even though a reinforcer was operating in the environment before introducing timeout. Paced instructions (delivering instructions to the child at a set pace regardless of the child's behavior) appears to be an alternative when timeout is not effective and, in conjunction with reinforcement, was demonstrated to reduce inappropriate behavior to near zero.
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This paper describes an experimental clinical approach to the problem child and his family, in which parents are trained to provide corrective social interaction experiences for the child. Negative interaction patterns are modified by teaching specific techniques of expressing warmth. Results of a pilot study indicate the technique is effective in working with immature and antisocial children who are hospitalized.
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A historical perspective was presented, attempting to trace how some clinical concepts and working assumptions, effective in the past, had drifted out of relationship with social changes, and were now considered by many as being myths. These included the assumption that developmental deviations such as autism were primarily normal responses to family stress and that autism primarily involved the child's social withdrawal from a hostile environment. In this paper some relationships between such myth beliefs and parental difficulties in managing their autistic child were identified. Specific management difficulties were distinguished from general ones. The latter manifest themselves in parental confusion, inappropriate expectations, and social role diffusion. Suggestions were made for helping parental management through changing treatment structures from traditional procedures.