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At least 19 recordsLinked to original sources
PubMed2001

Media-based behavioural treatments for behavioural disorders in children.

BACKGROUND: Prevalence studies show that behaviour problems in children are quite common (10-15% in preschoolers). These problems may manifest as, for example anxiety, sadness, over-activity and tantrums. Some studies have shown that these problems can be persistent, and that they lead to a range of problems in adolescence and adulthood. Many approaches are used to address behavioural problems such as medication, or more usually, psychological treatments either directly with the child and/or his/her family. Behavioural interventions have been shown to be highly effective but access to these treatments is limited due to factors such as time and expense. Presenting the information parents need in order to manage these behaviour problems in booklet or other media-based format would reduce the cost and thus increase access to these interventions. In the adult population it seems that media-based interventions such as these can be moderately effective. Given that the cost of media-based treatment is so low it is useful to know how effective they are when given to parents. It was hypothesised that media-based treatments would be less effective than conventional psychological treatments and that efficacy would improve with increasing amounts of therapist intervention. OBJECTIVES: To review the effects of media-based behavioural therapies (definitions below), for any young person with a behavioural disorder (however diagnosed) compared to standard care and no treatment controls. SEARCH STRATEGY: A range of electronic databases were systematically searched using a specified search strategy. Individual journals of interest were hand-searched where necessary, references in all selected trials were checked for other trials and, where it was thought to be of possible use, individual authors were contacted for additional information. SELECTION CRITERIA: Randomised controlled trials of behavioural media-based treatments for behaviour problems in children. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified from searches of electronic databases were read to determine whether they met the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by the reviewer and queries were resolved by discussion with an independent rater. Data were analysed using Revman. MAIN RESULTS: In general, media-based therapies for behavioural disorders in children had a moderate effect when compared with both no-treatment controls and with standard care. Significant improvements were often made with the addition of up to 2 hours of therapist time. REVIEWER'S CONCLUSIONS: These formats of delivering behavioural interventions for carers of children are possibly worth considering in clinical practice. For straightforward cases media-based interventions may be enough to make clinically significant changes in a child's behaviour, and reduce the amount of time primary care workers have to devote to each case. Consequently this would increase the number of families who could possibly benefit from this type of intervention. Media-based therapies would therefore appear to have both clinical and economic implications as regards the treatment of children with behavioural problems.

Caregivers↗
PubMed2004

Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities.

BACKGROUND: Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours run a long term course and are a major cause of social exclusion OBJECTIVES: To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities. SEARCH STRATEGY: The Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC and PsycINFO were searched using a strategy combining (Learning or synonyms) and (Disabilities or synonyms) and (Behaviour or synonyms) and (treatment or synonyms) to late 2002. Where appropriate, research filters were used. SELECTION CRITERIA: Studies were selected if more than 4 participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list. DATA COLLECTION AND ANALYSIS: References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. MAIN RESULTS: Three studies based on adult populations with learning disabilities were deemed to be suitable for inclusion but data were only available in a form suitable for meta-analysis in two studies. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment but not at follow up (up to six months) as rated by individuals and their carers. REVIEWERS' CONCLUSIONS: The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwards directed aggression in children and adults with ID is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.

Aggression↗
PubMed2002

Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children.

BACKGROUND: Mental health problems in children are common. Research suggests that parenting has an important role to play in helping children to become well adjusted adults, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social functioning which will in turn influence the child's future development and in particular, their mental health. Parenting programmes may therefore have a role to play in improving the mental health of infants and toddlers. OBJECTIVES: The objectives of this review are as follows: a) To establish whether group-based parenting programmes are effective in improving the mental health of children less than three years of age b) To assess the role of parenting programmes in the primary prevention of mental health problems SEARCH STRATEGY: A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC. SELECTION CRITERIA: Only randomised controlled trials were included and studies had to include at least one standardised instrument measuring some aspect of infant mental health. DATA COLLECTION AND ANALYSIS: The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented with 95% confidence intervals. Where appropriate the results have been combined in a meta-analysis using a random effect model. MAIN RESULTS: A total of five studies were included in the review. The 5 included studies provided a total of 36 assessments of infant and toddler mental health including emotional and behavioural adjustment, and sleep patterns. All of the results apart from 6 showed positive findings favouring the intervention group. While some of findings were non-significant, most of the effect sizes were large and the wide confidence intervals crossing the zero that were obtained in a number of the studies, were very probably due to small sample sizes. There was sufficient data from four studies to combine the results in a meta-analysis. The results of the meta-analysis show a significant difference in children's emotional and behavioural adjustment favouring the intervention group. Overall, the limited follow-up data provide equivocal evidence concerning the maintenance of these effects over time. REVIEWER'S CONCLUSIONS: The results of this review suggest that parenting programmes can be effective in improving the mental health of infants and toddlers. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of mental health problems. Furthermore, there is insufficient evidence to know whether the short-term benefit of these programmes is maintained over time, and further research is required.

Child Development↗
PubMed1999

Behavioural treatment for sleep problems in children with severe learning disabilities and challenging daytime behaviour: effect on daytime behaviour.

The study aimed to investigate a group of children with severe learning disabilities, challenging daytime behaviour, and severe sleep problems to see if successful behavioural treatment of the children's sleep problems resulted in reduced daytime challenging behaviour as reported by mothers and teachers. A randomised controlled trial of behavioural interventions for the children's sleep problems was conducted (N = 30). The intervention group received an individually tailored behavioural programme and were supported by telephone calls from the therapist. Baseline assessments of the children's behaviour were made using the Aberrant Behavior Checklist and were repeated 1 month and 3 months after the start of intervention. There were no behavioural changes that were specific to children in the treatment group. However, improvements in some behaviours were seen in both the intervention and the control group at the 1-month and 3-month assessments and there was agreement between mothers' and teachers' reports for many of these changes. The results suggest that nonspecific effects of participating in the study (including an increased sleep duration, which was seen in both groups), rather than resolution of sleep problem per se, may have a beneficial effect on child behaviour and these factors need to be identified for therapeutic use.

Analysis of Variance↗
PubMed2006

The theory of planned behaviour and binge drinking: Assessing the moderating role of past behaviour within the theory of planned behaviour.

A sample of 398 undergraduate students completed questionnaires assessing the main constructs of the theory of planned behaviour (TPB) in relation to binge drinking, as well as past binge drinking behaviour. Of these, 273 were followed up at 1 week. Regression analyses revealed attitude, self-efficacy, and perceived control (negative relationship) to be predictive of binge drinking intentions. Intention and self-efficacy were, in turn, predictive of binge drinking at 1-week follow-up. Past behaviour was found to explain additional variance in intention and behaviour. In addition, past behaviour was found to moderate the attitude-intention and intention-behaviour relationships, such that weaker relationships were observed with increasing frequency of past behaviour. The results are discussed in relation to the need to develop and test alternative measures of habit. The implications of the findings for interventions to encourage more appropriate drinking behaviour are outlined.

Adult↗
PubMed2005

Are techniques used in cognitive behaviour therapy applicable to behaviour change interventions based on the theory of planned behaviour?

The Theory of Planned Behaviour (TPB) is increasingly being used to inform the development of interventions to promote health behaviour change. However, although the theory can be used to identify the determinants of particular health-related behaviours, it offers little guidance on how to change these determinants and hence how to promote behaviour change. There is evidence that Cognitive Behaviour Therapy (CBT) can be used to support health behaviour change. This article discusses the similarities and differences between the two approaches, and considers whether techniques used in CBT are applicable to interventions based on the TPB.

Cognitive Behavioral Therapy↗
PubMed2003

Predicting behaviour from perceived behavioural control: tests of the accuracy assumption of the theory of planned behaviour.

The theory of planned behaviour assumes that the accuracy of perceived behavioural control (PBC) determines the strength of the PBC-behaviour relationship. However, this assumption has never been formally tested. The present research developed and validated a proxy measure of actual control (PMAC) in order to test the assumption. In two studies, participants completed measures of intention and PBC, and subsequently completed measures of behaviour and the PMAC. Validity of the PMAC was established by findings showing; (a). that the PMAC moderated the intention-behaviour relation, and (b). that PMAC scores did not reflect attributions for participants' failure to enact their stated intentions. Accuracy was operationalized as the difference between PBC and PMAC scores. Consistent with theoretical expectations, several analyses indicated that greater accuracy of PBC was associated with improved prediction of behaviour by PBC.

Feeding Behavior↗
PubMed1981

[Effects of behaviourally oriented sports therapy on anxiety behaviour in a learning and behaviourally impaired girl. (author's transl)].

This case-study of a 12-year old girl with learning and behavioural impairments investigates whether, and to what extent, a reduction of anxiety can be achieved by means of behaviourally oriented sports therapy. Following systematic use of behaviour therapy techniques as well as of model learning and systematic desensibilisation methods, significant modifications (p less than .05; p less than .01), or at least a tendency towards reduced anxiety ( p less than .10), have been stated both in respect of sports-related anxiety as well as of general and situational anxieties; assessment was made by means of the HANES KJ (Hamburg neuroticism and extraversion scale for children and adolescents), two sports-specific questionnaires, and a sports-motor test. No changes were stated using the AFS (anxiety questionnaire for students). The findings to a very large extent confirm our initial hypothesis that bodily movement is an agent capable of achieving anxiety reduction when behaviour therapy methods and techniques are used in the design of the sports activities.

Anxiety Disorders↗
PubMed2004

Which types of aggressive behaviour are associated with suicidal and self-injurious behaviour at the time of admission?

BACKGROUND: In psychiatry and psychotherapy, dealing with aggressiveness and autoaggressiveness is of great importance. Our aim was to find a link between overt aggressive and autoaggressive behaviour, which could be readily observed. SAMPLING AND METHODS: We investigated the frequency, type and intensity of aggressive, suicidal and self-injurious behaviour exhibited by 521 successively admitted psychiatric patients at the time of admission with the help of a standardised instrument (Social Dysfunction and Aggression Scale). The Social Dysfunction and Aggression Scale enables the investigation of 9 different types of overt aggressive behaviour and 2 different types of autoaggressive behaviour (suicidal vs. self-injurious behaviour). After calculating correlations between single variables, we attempted to estimate the predictive value of the different types of aggressive behaviour for suicidal and self-injurious behaviour by using ordinal regression models. In addition, the categorical information of our data was evaluated by loglinear analyses. RESULTS: Our study showed that all degrees of aggressiveness (low, moderate, high), which are exhibited in different types of aggressive behaviour, were linked to an increased risk of self-injurious behaviour. No correlation was found, however, between overt aggressive behaviour and suicidal behaviour. Only in the subgroup of depressive disorders did we establish that the risk of aggressive behaviour was decreased and the risk of suicidal behaviour was increased at the time of admission. CONCLUSIONS: The strong relationship between aggressive behaviour and self-injurious behaviour has previously been described in specific diagnostic subgroups, but not yet in a heterogeneous population of psychiatric in-patients from a defined catchment area. We, therefore, conclude that the link between aggressive and self-injurious behaviour could be a general one. Exhibiting aggressive behaviour and self-injurious behaviour within a short time span may be the result of an increased or disinhibited aggressive potential, which is independent of a specific diagnosis. As such, it possibly represents the general consequence of a highly altered state of mind and does not seem to be linked to a specific diagnostic subgroup. In psychiatric emergency situations, the previously described close relationship between aggressive and self-injurious behaviour should be taken into account.

Adolescent↗
PubMed1995

The theory of planned behaviour: the effects of perceived behavioural control and self-efficacy.

The present study was undertaken to assess the utility of the theory of planned behaviour, using separate measures of the two variables that are considered to comprise the notion of perceived behavioural control, namely, beliefs concerning the controllability of the behaviour and efficacy expectancies. The study was concerned with the prediction of intentions to engage in regular exercise (for at least 20 minutes, three times a week for a fortnight) and actual exercise behaviour. A sample of 146 undergraduate subjects participated in the study. It was prospective in design; measures of attitudes, norms, intentions, perceived control and self-efficacy were obtained at the first wave of data collection, while actual behaviour was assessed two weeks later. The results of the study revealed support for the view that separate measures of self-efficacy and perceived behavioural control should be employed in the theory of planned behaviour. In the first instance, confirmatory factor analysis revealed that the two variables could be empirically distinguished. Second, the effects of perceived behavioural control and self-efficacy on behavioural intentions and actual behaviour differed. As predicted, efficacy expectancies influenced behavioural intentions, but not actual behaviour. In contrast, levels of perceived behavioural control had no effect on behavioural intentions, but emerged as a significant (positive) predictor of actual behaviour (there was also evidence that the effects of intentions on behaviour were moderated by the level of perceived behavioural control).

Adult↗
PubMed2006

Using past behaviour and spontaneous implementation intentions to enhance the utility of the theory of planned behaviour in predicting exercise.

OBJECTIVES: This study examined the utility of the theory of planned behaviour (TPB), past behaviour, and spontaneous implementation intentions in predicting exercise behaviour. The psychological correlates of spontaneous implementation intentions and the moderating effects of intention, perceived behavioural control, past behaviour, and implementation intentions at various time points were also examined. DESIGN: Data collection occurred over three phases with a 2- and 3-week interval. The attrition rate was 35.97% leaving a total of 162 participants (63 males, 99 females). In the first wave, participants completed measures of TPB, spontaneous implementation intentions, and past behaviour. Behaviour was assessed in the second and third waves, and a follow-up measure of spontaneous implementation intentions was completed in Phase 3. RESULTS: Several regression analyses were conducted. Attitude towards exercise and perceived behavioural control made a significant contribution to the prediction of intention. Intention made a significant contribution to the prediction of implementation intentions. Spontaneous implementation intentions reduced the effect of intention and past behaviour for behaviour at 2 weeks and when indexed over a 5-week period. When behaviour was measured for a 3-week period (following an initial 2-week period), the variance that intention and past behaviour accounted for in exercise behaviour decreased, and spontaneous implementation intentions were no longer a significant predictor of behaviour. Spontaneous implementation intentions were found to interact with past behaviour, such that implementation intentions predicted exercise behaviour only among participants who did not exercise frequently in the past. CONCLUSIONS: Implications and future research directions are discussed.

Adolescent↗
PubMed2000

Cognitive behaviour therapy for schizophrenia.

BACKGROUND: Although medication is the mainstay of treatment for schizophrenia, always, some sort of informal or formal talking therapy is indicated. In cognitive behavioural therapy (CBT) links are made between the person's feelings and patterns of thinking which underpin their distress. OBJECTIVES: To review the effects of cognitive behaviour therapy (CBT) for those with schizophrenia compared to standard care, specific medication and non-intervention; also to review the effects of CBT for those with schizophrenia who are concurrently receiving standard care compared to no additional intervention to standard care, specific medication, additional drug interventions to standard care and other additional psychosocial interventions to standard care. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1998), CINAHL (1982-1998), The Cochrane Library (Issue 2, 1998), The Cochrane Schizophrenia Group's Register of Trials (August 1998), EMBASE (1980-1998), MEDLINE (1966-1998), PsycLIT (1887-1998), SIGLE (1990-1998), and Sociofile (1980-1998) were undertaken. All references of articles selected were searched for further relevant trials. SELECTION CRITERIA: Randomised trials of cognitive behaviour therapy for people with a diagnosis of schizophrenia, possible schizophrenia or mental illnesses where specific diagnoses have not been employed. Outcomes such as death, metal state, relapse, psychological well-being and acceptability of treatment were sought. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and assessed for methodological quality. Data were extracted by two reviewers working independently. Dichotomous data were analysed on an intention-to-treat basis and continuous data with 70% completion rate are presented. MAIN RESULTS: Four small trials were identified. All presented data suggested that there was a difference favouring CBT plus standard care over standard care alone in terms of reducing relapse rates (short term OR 0.31 CI 0.1-0.98; medium term OR 0.38 CI 0.17-0.83; long term OR 0.46 CI 0.26-0.83, NNT 6 CI 3-30). These findings were supported within the trials by scale-derived data. CBT, however, did not keep more people in care than a standard approach and there is no data relating to the effect of CBT on compliance with medication. One study also presented data on the effects of CBT when compared to supportive psychotherapy. No effect statistically significantly favoured either group but all were suggestive that the trial may have been underpowered to find an effect in favour of CBT. REVIEWER'S CONCLUSIONS: The results of well conducted and reported ongoing trials are eagerly awaited. Currently, for those with schizophrenia willing to receive CBT, access to this treatment approach is associated with a substantially reduced risk of relapse. However, at present CBT is a fairly scarce commodity, often provided by highly skilled and experienced therapists. Therefore, its application in day to day practice may be restricted by the availability of suitable practitioners. Similarly, the present data provides little indication of how effective CBT procedures might be when they are applied by less experienced practitioners.

Cognitive Behavioral Therapy↗
PubMed1994

Staff behaviour and its implications for people with learning disabilities and challenging behaviours.

Many people with learning disabilities engage in challenging behaviours which, behaviour analytic models suggest, are social behaviours sensitive to the actions of others in the environment. In this paper, the research literature on the behaviour of staff, especially that pertaining to interactions with people with challenging behaviours, is reviewed. Empirical evidence is found to support the hypothesis that staff actions affect clients' challenging behaviours. In addition, studies of staff behaviour show that their behaviour is often counter-habilitative. Firstly, staff spend little time interacting with clients and the quality of these interactions is often poor. Secondly, observational studies have shown that staff respond intermittently to challenging behaviours, and self-report studies indicate that many of these responses are of a nature that may reinforce such behaviours. Finally, although limited, evidence suggests that behavioural programmes for clients with challenging behaviours are rare and where they do exist they are often not carried out by staff. To date, interventions for staff behaviour (training and management approaches) have acted to change these ways of behaving but have not been founded on adequate analyses of staff action. A call is made for analyses of staff behaviour, and other implications for research and practical work with staff are discussed.

Humans↗
PubMed1999

Health and behaviour problems at 8 weeks as predictors of behaviour problems at 8 months.

OBJECTIVE: To assess the value of health and behavioural problems at 8 weeks as predictors of behavioural problems at 8 months in a whole year birth cohort. STUDY DESIGN: Prospective birth cohort study. SETTING: The socially and ethnically diverse city of Coventry. MAIN OUTCOME: Parent reported behavioural problems at 8 months. METHOD: Parent reported infant health and behaviour data were collected, using a validated questionnaire administered by the family health visitor at 8 weeks and 8 months, on 1541 infants participating in the Coventry cohort study. Sociodemographic data were collected at the health visitor's initial visit. Unadjusted relative risks (with 95% confidence intervals (CI)) of behaviour problems at 8 months by sociodemographic variables and health and behavioural problems at 8 weeks were estimated. Adjustment for confounding was made by logistic regression. RESULTS: Infants reported to have behavioural problems at 8 weeks had a significant risk of parent reported behavioural problems at 8 months (adjusted relative risk, 3.44; 95% CI, 1.95 to 6.09) after adjustment for other health outcomes and sociodemographic factors. Of infants with behavioural problems by 8 weeks of age, 19.1% were reported to have behavioural problems at 8 months. CONCLUSIONS: Infants whose parents report behaviour problems by 8 weeks of age are at higher risk of behavioural problems at 8 months. However, despite the higher risk, the proportions of infants identified by behaviour at 8 weeks were too small for the early outcomes to be useful as predictors of behaviour at 8 months in the whole infant population.

Child Behavior Disorders↗
PubMed1996

Risk-taking behaviour of Cape Peninsula high-school students. Part IX. Evidence for a syndrome of adolescent risk behaviour.

OBJECTIVES: To ascertain whether the notion of a syndrome of adolescent risk behaviour (which includes problem drinking, marijuana use, having experienced sexual intercourse, 'general deviance' and cigarette smoking) is valid for this setting; and to investigate whether suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome. DESIGN: Cross-sectional survey utilising a self-completed questionnaire; for both sexes, relationships between behaviours were documented as odds ratios. SETTING: High schools in the Cape Peninsula, South Africa. SUBJECTS: 7,340 students from 16 schools in the three major education departments. OUTCOME MEASURES: Participation in the following behaviours: alcohol bingeing, cannabis smoking, sexual intercourse, knife-carrying at school, cigarette smoking, attempting suicide, failure to use a seat belt, and walking home at night from beyond the neighbourhood. RESULTS: All the odds ratios were greater than 1. There were statistically significant odds ratios between all the pairs of risk behaviours included in the 'original' syndrome of risk behaviour except for cigarette smoking and having had sexual intercourse in the case of girls. There were statistically significant relationships between all these risk behaviours, suicidal behaviour, and behaviours that exposed the adolescent to risk of physical injury, except for failure to use a seat belt and: (i) suicidal behaviour for both sexes; and (ii) walking home alone at night and having had sexual intercourse in the case of girls. CONCLUSION: The notion of a syndrome of adolescent risk behaviour is valid for this population, and both suicidal behaviour and behaviour that exposes the adolescent to injury should be included in this syndrome.

Adolescent↗
PubMed2004

The effects of environmental pollutants on complex fish behaviour: integrating behavioural and physiological indicators of toxicity.

Environmental pollutants such as metals, pesticides, and other organics pose serious risks to many aquatic organisms. Accordingly, a great deal of previous research has characterized physiological mechanisms of toxicity in animals exposed to contaminants. In contrast, effects of contaminants on fish behaviour are less frequently studied. Because behaviour links physiological function with ecological processes, behavioural indicators of toxicity appear ideal for assessing the effects of aquatic pollutants on fish populations. Here we consider the many toxicants that disrupt complex fish behaviours, such as predator avoidance, reproductive, and social behaviours. Toxicant exposure often completely eliminates the performance of behaviours that are essential to fitness and survival in natural ecosystems, frequently after exposures of lesser magnitude than those causing significant mortality. Unfortunately, the behavioural toxicity of many xenobiotics is still unknown, warranting their future study. Physiological effects of toxicants in the literature include disruption of sensory, hormonal, neurological, and metabolic systems, which are likely to have profound implications for many fish behaviours. However, little toxicological research has sought to integrate the behavioural effects of toxicants with physiological processes. Those studies that take this multidisciplinary approach add important insight into possible mechanisms of behavioural alteration. The most commonly observed links with behavioural disruption include cholinesterase (ChE) inhibition, altered brain neurotransmitter levels, sensory deprivation, and impaired gonadal or thyroid hormone levels. Even less frequently studied are the implications of interrelated changes in behaviour and physiology caused by aquatic pollutants for fish populations. We conclude that future integrative, multidisciplinary research is clearly needed to increase the significance and usefulness of behavioural indicators for aquatic toxicology, and aim to highlight specific areas for consideration.

Animals↗
PubMed2001

Behaviour modification and gentle teaching workshops: management of children with learning disabilities exhibiting challenging behaviour and implications for learning disability nursing.

BACKGROUND: Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. OBJECTIVES: To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. DESIGN: Nonrandomized controlled trial. SETTING: Service users' homes in East Yorkshire. PARTICIPANTS: Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. PROCEDURE: One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. ANALYSIS: Quantitative analysis of pre-post differences between the groups, using t-test. RESULTS: In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teachingand behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. CONCLUSION: Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.

Adolescent↗
PubMed2002

Is social phobia related to lack of social skills? Duration of skill-related behaviours and ratings of behavioural adequacy.

OBJECTIVES: The aim of the current study was to investigate whether social phobics differ from clinically anxious and non-clinical comparison groups with regard to either the duration of skill-related behaviours displayed during a social conversation or their behavioural adequacy as perceived by observers. DESIGN: A between-group design was used for the first part of the study. The duration of specified skill-related behaviours of a group of socially phobic participants was compared with the behaviours of clinically anxious and non-clinical participants. A within-group design was used for the second part of the study. Observers' ratings of the adequacy of the behaviour of a subgroup of the participants from the three groups were evaluated. METHODS: Fifty-four participants, 18 socially phobic, 18 clinically anxious but not socially phobic and 18 who formed a non-clinical comparison group, took part in a 9-min conversation with a confederate of the experimenters. Participants were screened by diagnostic interview. Each conversation was videotaped, and from these recordings, the percentage time spent talking, spent in silence, smiling, maintaining eye contact while talking and while listening and while making manipulative gestures was extracted. A subset of 30 participants, 10 from each of the three groups, provided stimulus material for the second part of the study. The sixth minute of each of these 30 participants' recorded conversations was shown to 21 observers who rated the performance for adequacy of gestures, adequacy of eye contact, adequacy of smiling, clarity of speech, fluency of speech and overall adequacy of performance. Observers were also asked to categorize the participants based on the observed behaviour into one of three diagnostic groups: socially phobic, clinically anxious or non-clinical. RESULTS: Social phobics exhibited significantly less eye contact while talking in comparison with the non-clinical participants and significantly more manipulative gestures than either the clinically anxious or non-clinical participants. There were no other between-group differences in duration of skill-related behaviours. With regard to ratings of perceived behavioural adequacy for gestures, speech fluency and overall performance, the social phobic group was rated as significantly less adequate than both comparison groups. With regard to ratings of perceived adequacy of eye contact and speech clarity, while the anxious groups did not differ from each other, both were rated as significantly less adequate than the non-clinical comparison group. There was also a marked within-group variation in perceived adequacy of behaviour and wide variation in ratings provided by observers. CONCLUSIONS: Possible competing explanations for the results are discussed; these include the skills deficit hypothesis and the possibility that group differences in both duration of skill-related behaviour and observed behavioural adequacy reflect awkward, anxious behaviours and/or safety behaviours.

Adult↗