Effects of a Self-Monitoring Device on Socially Relevant Behaviors in Adolescents with Asperger Disorder: A Pilot Study

This article reports the results of two case studies. Two middle school-aged participants with high-functioning autism spectrum disorders were taught to self-monitor behaviors impacting their social acceptance by peers in their general education settings: oral self-stimulatory behaviors and conversation skills. Results indicate that the intervention was effective to some degree with both participants. As a result of the self-monitoring intervention, one participant decreased self-stimulatory behaviors; however, his data were highly variable throughout the study though lower on average during intervention than in baseline. The other participant's targeted skills in communication were only slightly improved. Self-monitoring using a vibrating reminder appears to be a low-cost intervention with high levels of social acceptability, low training requirements for teachers or students, and no social stigma.     

Fostering Locomotion Fluency of Five Adolescents with Rett Syndrome through a Microswitch-Based Program: Contingency Awareness and Social Rating

We further extended the use of a microswitch-based program for assessing contingency awareness and promoting locomotion fluency of five adolescents with Rett syndrome. A second goal was to evaluate the effectiveness and the suitability of the rehabilitative intervention on participants’ indices of happiness as outcome measure of their quality of life and on the reduction of their stereotypic behaviors. Finally, a social validation procedure involving 40 parents of children with severe developmental disabilities and 40 caregivers was carried out. The study was conducted according to an ABABCBCB experimental sequence for each participant, with A representing baselines, B indicating the contingent intervention closely linked to the adaptive responding, and C reporting a non-contingent control phase with positive stimulation occurring throughout the session, irrespective of the adaptive behavior. Results showed an improved performance for all the participants during contingent intervention phases. The control phases revealed that all participants acquired the contingency awareness. The indices of happiness increased as sign of an enhanced quality of life. Both groups of raters favorably scored the use of such technology. Clinical, practical, and psychological implications of the findings were discussed.     

The effects of planned activities training,low-demand schedule,and reinforcement sampling on adults with developmental disabilities who exhibit challenging behaviors

A case study is described in which Planned Activities Training (PAT), a low-demand schedule, and reinforcement sampling were used to decrease challenging behaviors in two adults with developmental disabilities. The two participants in the study were selected for the intervention based on their seriously challenging behaviors and the potential threat of injury to others. Data were collected on frequency of aggression and throwing for one of the participants, and aggression for the other participant during pre- and postintervention. A combined intervention of PAT (a treatment component consisting of advance preparation for activities, establishing rules, incidental teaching, and performance feedback), a low-demand schedule (with a gradual increase in demands as challenging behaviors decrease), and reinforcement sampling was provided for each participant. Following implementation of the intervention, data clearly demonstrated a decrease in frequency of challenging behaviors exhibited by both participants, suggesting that use of this combined intervention was instrumental in abtained change. A review of the value and of a case study is examined, with suggestions made for future research.     

An Evaluation of a Direct Instructions Flashcard System on the Acquisition and Generalization of Numerals, Shapes, and Colors for Preschool-Aged Students with Developmental Delays

The purpose of this study was to evaluate the effectiveness of the DI Flashcard system for teaching preliminary mathematic skills to three preschool students. The participants attended a self-contained special education preschool. All three participants’ eligibility category was “developmentally delayed”. A concurrent multiple baseline design across three sets (colors, shapes, and numerals) was use to evaluate the effectiveness of the DI flashcard system. The results indicated that all three participants showed an increase in their performance when DI flashcards were in effect. However, the amount of improvement varied for each participant. The importance of employing evidence-based procedures to teach skills to preschool students with developmental delays was outlined.     

Feasibility and Initial Efficacy Testing of an HIV Prevention Intervention for Black Adolescent Girls

HIV is disproportionately prevalent among Blacks. Black women most often contract HIV from having risky sex, and adolescence is a time when risky sex behaviors peak. This study tested the feasibility and initial efficacy of an intervention designed to help Black adolescent girls avoid risky sex behaviors. The intervention included group education for girls followed by a service learning opportunity in which the girls practiced the assertiveness and communication skills they had learned in the education sessions, and individual education for the girls’ mothers. The intervention was guided by a risk and protective factors framework and by the goal of promoting racial/ethnic pride in the girls. We determined that the intervention was feasible. Schools allowed recruitment of potential participants and the use of their facilities for meeting with the girls. We encountered little participant dropout from the study, and the intervention was highly regarded by the girls who participated and their mothers. We found improvements in aspects of the girls’ relationships with their mothers, their sexual assertiveness, and their self-efficacy to use condoms.     

Application theory of planned behavior on promotion of safe sexual behaviors among drug users

The aim of this study was to apply the theory of planned behavior on the promotion of safe sexual behaviors among drug users covered by Fasa’s drug user’s center. In the phase I of this study, 225 men drug users referring to rehabilitation centers in Fasa City, Fars Province, Iran were selected by simple sampling method in 2016. Also, in a quasi-experimental study in the second phase, 120 drug users participated (60 participants in the experimental group and 60 participants in the control group). Data were collected using a questionnaire containing demographic information and the theory of planned behavior constructs which was distributed before and three months after the intervention.61. 33% of the participants had the history of extramarital sexual intercourse and 28% had used condoms in their last sexual intercourse. After educational intervention, the mean scores of the theory constructs, in the intervention group increased significantly (P < 0.001), while the changes were not significant in the control group. Moreover, 65% of the drug users in the intervention group had safe sex behaviors.     

Comparing Three Augmentative and Alternative Communication Modes for Children with Developmental Disabilities

We compared acquisition, maintenance, and preference for three AAC modes in four children with developmental disabilities (DD). Children were taught to make general requests for preferred items (snacks or play) using a speech-generating device (SGD), picture-exchange (PE), and manual signs (MS). The effects of intervention were evaluated in a multiple-probe across participants and alternating-treatments design. Preference probes were also conducted to determine if children would choose one AAC mode more frequently than the others. During intervention, all four children learned to request using PE and the SGD, but only two also reached criteria with MS. For the AAC preference assessments, three participants chose the SGD most frequently, while the other participant chose PE most frequently. The results suggest that children’s preference for different AAC modes can be assessed during the early stages of intervention and that their preferences may influence acquisition and maintenance of AAC-based requesting responses.     

Outcomes of a nonaversive behavior intervention in intellectually impaired individuals using goal attainment scaling.

BACKGROUND: Intellectually impaired individuals with severe behavior problems pose a challenge to caregivers in treatment and management. The use of behavioral intervention techniques, for example, differential reinforcement of other behavior (DRO), has been shown the most effective with this client group type. Studies suggest that DRO is effective and may result in generalization of treatment effects. OBJECTIVES: To test which of three behavior interventions (DRO, mutual goal setting [MGS], and routine care) improve self-care behaviors in moderately intellectually impaired individuals with behavioral problems, and to examine whether the use of goal attainment scaling (GAS) in evaluating interventions reflects improvement in self-care behavior. METHOD: A quasi-experimental design with small-group and single-subject repeated measures were used. The participants (15 congenitally moderately intellectually impaired residents with inadequate self-care behaviors) were randomly assigned to one of the three interventions for fostering self-care behaviors. To evaluate the outcome of treatment, GAS was used. Staff in the DRO and MGS groups developed and evaluated rehabilitation plans with each participant. Participants in the DRO group, but not the MGS group, were positively reinforced immediately. Staff in the routine care group assisted residents. The intervention continued for 22 weeks; follow-up was 16 weeks. RESULTS: A change score was calculated from the GAS for each participant and group. The expected range of mean GAS scores for individuals and groups was between 23 and 77, with 23 (-2) representing less than and 77 (+2) much more than expected improvement. CONCLUSIONS: Findings showed DRO to be more effective than the other interventions in improving self-care behaviors. Comparisons of the GAS mean baseline and mean intervention scores in all three interventions demonstrated the actual improvement in the self-care behaviors.     

Decreasing Pica Attempts by Manipulating the Environment to Support Prosocial Behavior

It is well established in the literature that pica displayed by individuals with developmental disabilities is most likely to be maintained by automatic reinforcement. However, there is a need for additional research regarding interventions that emphasize skill acquisition by teaching individuals with automatically maintained pica, multiple alternative behaviors to reduce the occurrence of this behavior. For the current study, pica emitted by three participants with developmental disabilities was targeted for assessment and treatment. Results of a functional behavioral assessment, which included a functional analysis, showed each participant’s pica was maintained by automatic reinforcement. Treatment was individualized for each participant, but primarily focused on response interruption and redirection, as well as differentially reinforcing alternative behaviors such as discarding and vacuuming potential pica items. After thinning the schedule of reinforcement for each participant, treatment was generalized across settings and people. Overall, low rates of pica were maintained over time for all participants.     

Video Self-Prompting and Mobile Technology to Increase Daily Living and Vocational Independence for Students with Autism Spectrum Disorders

Three male high school students with autism spectrum disorders participated in this study. Vocational and daily living skills were taught using video prompting via an iPhone. Specifically, using a washing machine, making noodles, and using a copy machine were taught. A multiple probe design across behaviors replicated across participants was used to evaluate the effectiveness of the intervention. Results indicate that the three participants increased performance across all behaviors by increasing the percent of steps performed independently. This study introduces a novel approach to using instructional video, in that two of the three students were able to learn how to self-prompt with the iPhone and ultimately teach themselves the target skills. Maintenance probes were also conducted and the iPhone had to be returned to all three participants for two out of three behaviors for a return to criterion levels. In addition to study limitations, implications for practice for video self-prompting are discussed.     

An Initial Evaluation of Trial-Based Functional Analyses of Inappropriate Mealtime Behavior

Treatment of inappropriate mealtime behavior (IMB) should involve a functional analysis to determine variables maintaining the target behaviors. The purpose of the present study was to evaluate the trial-based functional analysis of IMB and assess correspondence of the results with a traditional functional analysis. The participants were two boys, ages 3 and 5 years old, diagnosed with developmental disabilities. A trial-based functional analysis and traditional analogue functional analysis of IMB were conducted with each participant, with the order of functional analyses counterbalanced across participants. The trial-based functional analysis resulted in differentially higher levels of IMB in one or more test conditions, indicating a social function of IMB for both participants. In addition, the results of the trial-based and traditional functional analysis corresponded for both participants. The subsequent function-based intervention, developed based on the results of the trial-based functional analysis, was associated with a decrease in IMB and an increase in appropriate feeding behaviors for both participants. The results of this study provide initial support for the use of trial-based functional analysis to assess the function of IMB.     

Heart Rate Assessment and Use of a Multiple Schedule Treatment for an Individual with Obsessive Compulsive-like Behavior

Repetitive behavior is displayed by individuals with Autism Spectrum Disorder and those with Obsessive Compulsive Disorder (American Psychiatric Association 2013). Clinicians assessing individuals with autism who display stereotypic behavior face the challenge of determining whether or not these repetitive behaviors are more reflective of topographies observed in individuals with developmental delays, or are more representative of those observed in OCD. The distinction is important because traditional treatments for OCD have addressed the discomfort associated with repetitive acts, which has been described as a building urge that precedes compulsive behavior. In contrast, treatments for stereotypic behavior in children with autism may involve signaled periods of access to repetitive behavior which could inadvertently lead to a child encountering conditions which elicit stress as part of a treatment approach. One potential way to capture a building state of distress in a client with repetitive behavior is through the measurement of heart rate. The current study evaluated heart rate variability during conditions in which an establishing operation was either present or absent for the arranging behavior of a child with autism, as well as when access to arranging was allowed. When significant differences were not observed across these conditions, a multiple schedule treatment for arranging was implemented and demonstrated to be an effective way to manage the participant’s compulsive behavior. The treatment was implemented in the home setting and the participant’s parent was also able to demonstrate the ability to effectively implement the intervention.     

Effectiveness of Increasing Emergency Department Patients' Self-perceived Risk for Being Human Immunodeficiency Virus (HIV) Infected Through Audio Computer Self-interview–based Feedback About Reported HIV Risk Behaviors

Objectives: Prior research has demonstrated that emergency department (ED) patient acceptance of human immunodeficiency virus (HIV) screening is partially dependent on patients’ self-perceived risk of infection. The primary objective of this study was to determine the effectiveness of audio computer-assisted self-interview (ACASI)-based feedback. The intervention aimed to increase patient’s self-perceived risk of being HIV infected by providing immediate feedback on their risk behaviors. Methods: This 1-year, randomized, controlled trial at a U.S. ED enrolled a random sample of 18- to 64-year-old subcritically ill or injured adult patients who were not known to be HIV infected. All participants completed an anonymous, ACASI-based questionnaire about their HIV risk behaviors related to injection drug use and sex, as well as their self-perceived risk for being HIV infected. Participants were randomly assigned to one of two study groups: an intervention group in which participants received immediate ACASI-based feedback in response to each of their reported risk behaviors or a no-intervention group without feedback. Participants were asked to indicate their level of HIV risk on a five-point scale before and after they answered the questions. Change in level of self-perceived HIV risk was calculated and compared by study group using Pearson’s chi-square test. An HIV risk behavior score that summarized reported HIV risk behavior was devised. Because HIV risk behaviors differ by sex, scores were calculated separately for each sex. Linear regression models that adjusted for study group and same subject covariance were employed to determine if higher HIV risk behavior scores were associated with an increase in self-perceived HIV risk. Results: Of the 566 trial participants, the median age was 29 years (interquartile range [IQR] = 22–43 years), 62.2% were females, and 66.9% had been tested previously for HIV. After answering the reported HIV risk behavior questions, 12.6% of participants had an increase, 79.9% had no change, and 7.5% had a decrease in self-perceived HIV risk. Of the 46.6% of participants who initially indicated that they were not at risk for HIV, 11.4% had an increase in self-perceived HIV risk after answering the reported HIV risk behavior questions. Change in self-perceived HIV risk did not differ by study group (p = 0.77). There were no differences in reported HIV risk scores between the intervention and no-intervention groups for females (p = 0.78) or males (p = 0.86). In the linear regression models, a greater increase in self-perceived HIV risk was associated with higher reported HIV risk behavior scores for females (β = 0.59, 95% confidence interval [CI] = 0.15, 1.04) but not for males (β = 1.00, 95% CI = −0.13 to 2.14). Conclusions: Some ED patients can be moved, although modestly, to recognize their risk for being HIV infected by asking about their HIV risk behaviors. However, ACASI-based feedback messages about HIV risk behaviors do not increase subjects’ self-perceived HIV risk. Female ED patients appear to increase their self-perceived HIV risk more than males when queried about their HIV risk behaviors.     

Effectiveness of a nursing board games in psychiatric nursing course for undergraduate nursing students: An experimental design

AimTo examine the effectiveness of a psychiatric nursing board game in an undergraduate psychiatric nursing course.BackgroundDidactic teaching fails to assist students in deepening their understanding of abstract concepts in psychiatric nursing. The game-based learning of professional courses can address the demands of digital-age students, which may improve their learning outcomes.DesignA parallel two-arm experimental design was adopted in a nursing college in southern Taiwan.MethodsThe participants were fourth-year students enroled in a college nursing programme in southern Taiwan. Simple random sampling was used to divide the class into intervention and control groups. The former participated in an eight-week game-based intervention course, while the latter continued to receive traditional instruction. In addition to collecting the students’ demographic data, three structural questionnaires were developed to examine the variation in students’ nursing knowledge and attitudes toward psychiatric nursing, as well as their learning satisfaction before and after the intervention.ResultsThere were a total of 106 participants, with 53 in each group. After the intervention, the two groups were significantly different in terms of their psychiatric nursing knowledge, attitudes and self-reported learning satisfaction. The intervention group’s scores were significantly higher than those of the control group across all three dimensions. This suggests the positive effects of the board game intervention on students’ learning outcomes.ConclusionThe research outcome can be applied in formative and undergraduate nursing education in teaching psychiatric nursing globally. The game-based learning materials developed can be used to train psychiatric nursing teachers. Future studies should recruit a larger sample and increase the follow-up time for assessing students’ learning outcomes, as well as examine the similarities and differences in the learning outcomes of students from different educational systems.     

In-process modification yields improved teaching outcomes for international emergency medicine

Aims

To determine if on-going modification of an international teaching course in emergency medicine will improve audience perception and receptivity.

Methods

Over 4 years, we conducted surveys during emergency medicine symposiums given in Ghana, West Africa. In 2003, 2004 and 2006, symposium interventions of content modification (lecture topics/workshops), audience modification (smaller groups, designing workshops for different levels of providers) and in-process modification (modification of lecture technique in two sequential 2006 symposiums) were done. Survey responses were analyzed to determine what interventions resulted in greater participant satisfaction. When comparing the three groups, a one-way ANOVA test was conducted to determine differences among the 3 years. When comparing two groups, Levene’s test for equality of variances was conducted for annual variance, and based on that result, an independent t-test was calculated.

Results

The one-way ANOVA test indicated that there was a statistically significant difference among the three groups (2003, 2004, 2006) of symposium participants in four questions related to the participants’ perception of the instructors. The independent t-test comparing the aggregate data of 2003 and 2004 with 2006 (audience modification and in-process modification between two sequential symposiums) showed a statistically significant improvement in the participants’ receptivity. The data indicated that modifying the content of international symposiums and modifying the audience to which it is addressed are equally valuable tools to ensure a positive participant receptivity. Moreover, the data indicated that “in-process” modification conducted between the two sequential 2006 symposiums produced a statistically significant increase in positive perception, facilitating knowledge transfer.

Conclusion

Statistical analysis of surveys coupled with modification and intervention can improve participant satisfaction in international teaching programs.     

Feasibility and initial efficacy testing of an HIV prevention intervention for Black adolescent girls

HIV is disproportionately prevalent among Blacks. Black women most often contract HIV from having risky sex, and adolescence is a time when risky sex behaviors peak. This study tested the feasibility and initial efficacy of an intervention designed to help Black adolescent girls avoid risky sex behaviors. The intervention included group education for girls followed by a service learning opportunity in which the girls practiced the assertiveness and communication skills they had learned in the education sessions, and individual education for the girls’ mothers. The intervention was guided by a risk and protective factors framework and by the goal of promoting racial/ethnic pride in the girls. We determined that the intervention was feasible. Schools allowed recruitment of potential participants and the use of their facilities for meeting with the girls. We encountered little participant dropout from the study, and the intervention was highly regarded by the girls who participated and their mothers. We found improvements in aspects of the girls’ relationships with their mothers, their sexual assertiveness, and their self-efficacy to use condoms.     

Stroke Health and Risk Education (SHARE): design, methods, and theoretical basis

BACKGROUND: Stroke is a disease with tremendous individual, family, and societal impact across all race/ethnic groups. Mexican Americans, the largest subgroup of Hispanic Americans, are at even higher risk of stroke than European Americans. AIM: To test the effectiveness of a culturally sensitive, church-based, multi-component, motivational enhancement intervention for Mexican Americans and European Americans in reducing stroke risk factors. METHODS: Participants enroll in family or friendship pairs, from the same Catholic church in the Corpus Christi Texas area, and are encouraged to change diet and physical activity behaviors and provide support for behavior change to their partners. Churches are randomized to either the intervention or control group. Goal enrollment for each of the 10 participating churches is 40 participant pairs. The intervention consists of self-help materials (including a motivational short film, cookbook/healthy eating guide, physical activity guide with pedometer, and photonovella), five motivational interviewing calls, two tailored newsletters, parish health promotion activities and environmental changes, and a peer support workshop where participants learn to provide autonomy supportive counseling to their partner. SHARE's three primary outcomes are self-reported sodium intake, fruit and vegetable intake, and level of physical activity. Participants complete questionnaires and have measurements at baseline, six months, and twelve months. Persistence testing is performed at 18 months in the intervention group. The trial is registered with clinicaltrials.gov (NCT01378780).     

Beliefs about appropriate pain behavior: cross-cultural and sex differences between Japanese and Euro-Americans.

The Appropriate Pain Behavior Questionnaire (APBQ) was employed to examine the effects of the participants' sex and culture on their beliefs regarding gender-appropriate pain behavior. The APBQ examines beliefs about the social acceptability to male and female participants of the behavioral and verbal expressions of pain by men and women (referents) in the presence of others [Nayak, S., 2000. Cross Cult Research 34, 135-151]. The participants were 18 male and 14 female Japanese, and 11 male and 21 female Euro-Americans. There was a significant effect of sex: female participants considered pain behaviors more acceptable than male participants. There was a significant effect of culture: compared to both male and female Japanese, Euro-American participants rated pain behaviors in both sexes to be more acceptable. There was also a significant effect of referent gender: for both sexes in both cultures, pain behaviors in women were rated as more acceptable than in men. Furthermore, a significant interaction was found between referent gender and sex of the participant: Male and female participants of both cultures were equally accepting of pain behaviors in women, but male participants were less accepting of pain behaviors in men than in women. There also was a significant interaction between referent gender and culture of the participant: Japanese participants considered pain behavior in both genders to be less acceptable than did Americans. The results are explained in terms of cultural traditions and social roles, and have clear implications for clinical treatment and diagnosis.     

Microswitch-aided Programs for a Woman with Rett Syndrome and a Boy with Extensive Neuro-motor and Intellectual Disabilities

The purpose of this study was to extend the evidence on microswitch-aided programs in terms of participants involved and responses adopted. One of the two participants in this study was a woman with Rett syndrome. Adults with this syndrome have not been involved in microswitch programs and the possibility of achieving positive effects with her was viewed as relevant for future work with this group of persons. The responses used for the woman and the second participant (i.e., a boy with extensive neuro-motor and intellectual disabilities) consisted of flexible head and right hand activations, respectively. Flexibility meant that such activations could occur via left or right head movements, or through forward, upward, or downward hand movements. Allowing the participants to use any of several movements (rather than a single/specific one) was thought to make their response easier, given their limited control of their neuro-motor behavior. The possible impact of the program on the participants’ mood (happiness) was also assessed. Data showed an increase in microswitch responses and level of happiness for both participants during the intervention phases of the study. The practical implications of these findings are discussed.