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A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.

Adolescent↗

Antecedent-consequence conditions in maternal mood and child adjustment: a four-year cross-lagged study.

Examined the mutual influence on maternal depressive symptoms and child adjustment problems and their antecedent-consequence conditions across 3 cycles of panel data collected over a 4-year period in the National Longitudinal Survey of Children and Youth (NLSCY). Results indicated stability in, and relations between, maternal and child outcomes. Cross-lagged panel correlations showed that maternal depressive symptoms tended to precede child aggression and hyperactivity but tended to follow child emotional problems. Temporal relations were interpreted in the context of mechanisms that transmit risk between mothers and children. Logistic regression analysis showed bidirectional risk between maternal mood and child adjustment after earlier symptoms were statistically controlled. These findings indicate that maternal depression increases the risk of adjustment problems in children, and vice versa, underscoring the intergenerational transmission of psychopathology.

Adjustment Disorders↗

Emergence of compulsive behavior and tantrums in children with Prader-Willi syndrome.

Many adults with Prader-Willi syndrome are affected by behaviors such as tantrums, skin-picking, and compulsions. The nature and extent of these problems suggest more attention be directed to their emergence in childhood. Our purpose was to investigate behavior problems in children with this syndrome and identify the age at which these behaviors emerge. Parents of children with Prader-Willi syndrome, Down syndrome, and those developing typically completed questionnaires. Children with Prader-Willi syndrome exhibited more compulsions, skin-picking, and tantrums than did the other groups. A discriminant analysis of behavior variables derived two statistically significant functions that were interpreted as developmental milestones and problematic behavior. These functions correctly predicted membership for 79% of grouped cases.

Child↗

Contingent observation: an effective and acceptable procedure for reducing disruptive behavior of young children in a group setting.

Since a major task of childhood is learning to get along in a group without disrupting other children's activities, caregivers need explicit guidelines for gentle but effective procedures for dealing with disruptive behaviors in child-care settings. In a day-care center for normal 1- and 2-yr.-old children, an effort was made to develop a procedure that appeared sufficiently humane and educational to be acceptable to parents and day-care workers, and yet effective in reducing disruptive play behaviors. Caregivers used the occasion of disruptive behavior to instruct the child in appropriate alternatives, then had the child sit on the periphery and observe the appropriate social behavior of the other children "sit and watch", for a brief period before inviting him or her to rejoin the play activities. The effectiveness of this procedure was compared with a method commonly recommended for the use with young children: instructing the child, then distracting or redirecting the child to an alternative toy or activity. Contingent observation, combining instruction with a brief timeout (from being a participant in an activity to becoming an observer of the activity), proved considerably more effective in maintaining low levels of disruptions and was considered by caregivers and parents to be an appropriate and socially acceptable method of dealing with young children's disruptive behaviors. Therefore, contingent observation can be recommended for general use in day-care programs for young children.

Attention↗

Teaching children appropriate shopping behavior through parent training in the supermarket setting.

The shopping behavior of three elementary school-age boys was analyzed and parent-child interactions assessed for one boy and his mother. Estimates of parent of consumer satisfaction with child shopping behavior were also obtained. The effects of a parent-mediated treatment package on child behavior were assessed using a multiple-baseline design. Treatment produced significant increases in appropriate shopping behavior in all three children and parents became increasingly satisfied with improved child behavior. Analysis of data for one mother also revealed that her manner of interacting with her child became more positive.

Behavior Therapy↗

Compliance training and behavioral covariation in the treatment of multiple behavior problems.

The present study investigated the use of a compliance-training procedure and its effect on untreated deviant child behaviors. Three children, each generally noncompliant to adult requests and with several additional problems, such as crying, aggression, and self-injurious behavior, were trained in the compliance procedure under a multiple-baseline design across therapists. Compliance was defined as the correct response to prespecified requests. Other classes of deviant child behavior were measured continuously throughout the study but not directly reinforced. The results of the study showed that (a) increases in compliance to requests were directly related to the contingencies employed; (b) decreases in untreated deviant behaviors occurred when compliance increased, even though no direct contingencies had been placed on these behaviors; and (c) the relationship between untreated deviant behaviors and compliance appeared to be maintained by a different set of events in each of the three children. The results are discussed in terms of behavioral covariation and generalization.

Aggression↗

Long-term effects of oppositional child treatment with mothers as therapists and therapist trainers.

The follow-up data reported represent a long-term (3 to 9 years out of treatment) evaluation of 40 children who were clients of the Regional Intervention Program (RIP) from 1969 to 1978. As 3-, 4-, and 5-year olds, these youngsters exhibited severe and prolonged tantrums, continual opposition to adults' requests and commands, and physical aggression toward parents. Each child and mother participated in a standardized intervention package modeled after Wahler's Opposition Child Treatment. Results from school and home-based follow-up showed that: (a) commands, demands, or requests made by parents were likely to be followed by former clients' compliance; (b) former clients' social interactions in the homes were overwhelmingly positive and their nonsocial behavior was by and large appropriate; (c) parent behavior in the home was consistent with the child management skills taught many years ago; (d) there were no differences between the compliant, on-task, social interaction and appropriate/inappropriate nonsocial behaviors of former clients and randomly selected class peers; (e) there were no differences in teachers' commands, negative feedback, positive social reinforcement, and repeated commands that were directed toward either former clients or randomly selected class peers; (f) both teachers' and parents' rating of former clients on the modified Walker Problem Behavior Checklist were highly correlated; (g) there were no differences in teachers' rating of former clients and class peers; and (h) of all the studied demographic variables, only age that treatment began and family intactness were related to current levels of behavior.

Behavior Therapy↗

Dining out with children: effectiveness of a parent advice package on pre-meal in appropriate behavior.

The effectiveness of an advice package designed to restructure the restaurant environment and encourage parent praise was examined. Experiment 1 assessed the usefulness of the package when used with experimenter assistance. Videotapes were used to record the target child's behavior. Pre-meal inappropriate behavior decreased an average of 51% across target children. Mealtime inappropriate behavior and parent praise and disapproval were also measured. Experiment 2 was designed to determine whether families could implement the package without experimenter assistance and whether effects obtained would generalize to a different restaurant. Data were taken in vivo. Nine families were randomly assigned to one of three groups. Group assignment determined the order in which families went to two restaurants, the number of dinners each family participated in, and the point at which parents received the advice package. The order in which the families went to the two restaurants as well as the number of baseline meals was counterbalanced. Results of Experiment 2 showed that, when using the advice package, parents in all sequences were able to decrease pre-meal inappropriate behavior of their children, and that these effects generalized to a second restaurant.

Behavior Therapy↗

The effects of a child's self-evaluation program on compliance with parental instructions in the home.

A self-evaluation program was implemented with a kindergarten-aged boy in the home to increase compliance with parent instructions and decrease inappropriate verbal behavior. The self-evaluation package included the child's assessing the appropriateness of his behavior in 5-min intervals, receiving chips for positive self-evaluations, and exchanging chips for a reward following experimental sessions. In a reversal design, analyses were conducted of the effectiveness of the self-evaluation program, the requisite conditions for effective child behavior change with a self-evaluation approach, and the parent's efficiency in using the self-evaluation package. The self-evaluation procedures typically resulted in increased compliant behavior and decreased inappropriate behavior, although the effects generally weakened with time. Behavioral gains were greater and better maintained when the self-evaluation procedures were preceded by a phase of external evaluation via the mother than by baseline, suggesting that self-evaluation procedures may serve more to maintain the effects of external evaluation rather than to induce their own changes. The parent generally was efficient in implementing the procedures. Research and clinical implications for using self-evaluation procedures in a home setting are discussed.

Behavior Therapy↗

Maintenance factors in coercive mother-child interactions: the compliance and predictability hypotheses.

Two stimulus control processes by which some parent-child dyads occasionally escalate their aversive exchanges into progressively more coercive interactions are described. The compliance hypothesis suggests that aversive actions have instructional properties for the dyad and that parent compliance with such child instructions maintains behavior chains of increasing aversiveness. The predictability hypothesis suggests that social interactions are most likely to function as aversive stimuli in the dyad when delivered in unpredictable fashion by either party and that responses instrumental in reducing dyadic unpredictability maintain aversive behavior chains. Expectations derived from both hypotheses are evaluated in a series of correlational analyses of mother-child interactions obtained in extended baseline observations of three dyads seeking psychological help for severe interactional problems. Results provide tentative support for the predictability hypothesis and suggest important avenues of further research.

Aggression↗

Experimental analysis of response covariation among compliant and inappropriate behaviors.

Reliable changes in a variety of behaviors, or classes of behaviors, when only one is manipulated experimentally, have demonstrated that even topographically dissimilar responses can be functionally related. We investigated such a relationship between topographically different child behaviors (compliance and inappropriate activities) by using a methodology that tests for response covariation. Five conditions were provided to sequentially increase and decrease first one and then the other of these behaviors, with the degree of covariation between the two behaviors (i.e., the relationship between changes in the targeted and nontargeted behaviors) being the finding of interest. Results showed that, regardless of the intervention used, the behavior targeted, or the direction manipulated, the nontargeted behavior reliably covaried inversely with the targeted one. The findings have immediate relevance to the clinical treatment of multiple behavior problems exhibited by children. Furthermore, the study of relationships between responses and the processes underlying these relationships can have important implications for understanding the complexity characteristic of human behavior not yet analyzed by behavioral research.

Behavior Therapy↗

A brief component analysis of potential treatment packages in an outpatient clinic setting with young children.

The purpose of this study was to develop outpatient clinic assessments that allowed us to assess multiple treatment variables, produce relatively quick effects, and isolate active treatment components. Assessment began by evaluating a treatment package consisting of antecedent and consequence variables followed by a component analysis to determine the separate effects of the treatment variables. Three examples of the findings are presented.

Ambulatory Care↗

Brief hierarchical assessment of potential treatment components with children in an outpatient clinic.

Seven patients conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these 6 children, improved behavior occurred with changes in treatment components. Our results extend previous studies of direct assessment procedures conducted in outpatient clinic settings.

Ambulatory Care↗

Analysis of a high-probability instructional sequence and time-out in the treatment of child noncompliance.

This study evaluated the effectiveness of high-probability requests and time-out as treatments for noncompliance that appeared to be maintained by contingent attention in 2 developmentally normal children. The introduction of high-probability requests increased compliance for 1 child but not the other. Time-out was effective with both children, and improvements in compliance were maintained at an 8-week follow-up.

Behavior Therapy↗

Competence in aspects of behavioral treatment and consultation: implications for service delivery and graduate training.

This study examined the extent to which competence in applying behavioral procedures (time-out from positive reinforcement) was sufficient to establish competence in teaching others to apply the same procedures. During baseline, graduate students attempted to instruct parents with a history of child abuse and neglect in the use of time-out. Students were then instructed in the use of time-out until they achieved proficiency in a role-play context. They then reattempted to instruct the parents. Finally, the students were instructed in certain consultation skills (i.e., teaching others to apply behavioral procedures) and again attempted to instruct parents in the application of time-out. Observations of students' consultation skills, parents' proficiency at administering time-out, and children's compliance to parental instructions revealed that explicit training in behavioral consulting skills was necessary to produce improvements in these behaviors. Students proficiency at administering time-out was insufficient to enable them to instruct others in its application. These results were corroborated by surveys of both students and staff. The implications for graduate training and service delivery are discussed.

Adult↗

Defining child noncompliance: an examination of temporal parameters.

This study examined compliance parameters for 53 clinic-referred and nonreferred children, ages 2 to 10 years. Although there were significant differences between the referred and nonreferred samples for percentage compliance, there were no significant differences between the referred and nonreferred samples in terms of initiation or completion latencies. The average initiation latency was 5.92 s, whereas 98% of the sample initiated compliance within 14 s. Younger children did take longer to complete tasks. Results suggest that the use of short latencies in defining noncompliance may represent overly conservative criteria.

Behavior Therapy↗

The effect of reinforcer preference on functional analysis outcomes.

We combined functional analyses and concurrent-schedule assessments to identify reinforcer preference during situations in which problem behavior may have been multiply controlled. Participants were 3 children with developmental delays who engaged in problem behavior during toy play with another child and one adult present, suggesting that problem behavior may have been maintained by adult attention or access to tangible reinforcement. Thus, conditions were designed to test attention and access-to-toys hypotheses. Initial functional analyses suggested multiple control. Subsequent concurrent-schedule assessments identified preference between the reinforcers, and treatments were based on these findings. Findings are discussed regarding the assessment of potentially multiply controlled problem behavior.

Adult↗