Using functional equivalence training to reduce severe challenging behavior: A case study

A case study is described in which functional equivalence was used to reduce severe tantrums and property destruction by an 8-year-old boy with autism. Although data were collected on the frequency of these behaviors, no treatment was applied directly to them. Rather, the child and his mother were taught functional communication training and the mother was taught activity planning. As the boy gained communication skills, his tantruming and property damage were virtually eliminated. The value of case studies is also discussed.University of Judaism.     

A developmental framework for distinguishing disruptive behavior from normative misbehavior in preschool children

BACKGROUND: Attaining a developmentally sensitive nosology for preschool disruptive behavior requires characterization of the features that distinguish it from the normative misbehavior of this developmental period. We hypothesize that quality of behavior and its pervasiveness across contexts are critical dimensions for clinical discrimination in young children and propose that structured diagnostic observation provides a systematic method for their identification. We use the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) to examine whether: (a) observed quality and pervasiveness of behavior distinguishes preschoolers with clinically concerning disruptive behavior from typically developing preschoolers, and (b) observed pattern of clinically salient behavior predicts impairment above and beyond maternal report of behavioral frequency. METHODS: Participants are a behaviorally heterogeneous sample of preschoolers (N = 327). Diagnostic methods developed for clinical assessment of preschoolers were used to classify children as (a) Non-Disruptive, (b) Sub-Clinical, or (c) Disruptive. Child behavior was coded based on interactions with parent and examiner during the DB-DOS. RESULTS: Quality and pervasiveness of observed behaviors during the DB-DOS significantly distinguished the three behavioral groups. Discriminative utility varied depending on the comparison. With few exceptions, clinically concerning patterns on the DB-DOS added significant incremental utility in predicting impairment. CONCLUSIONS: Observed patterns of clinically salient behavior show promise for advancing developmentally-informed characterization of disruptive behavior within the preschool period.     

李发枝教授艾滋病临证学术思想浅析

艾滋病是人类因为感染人类免疫缺陷病毒(Human Immunodeficiency Virus,HIV)后导致免疫缺陷,并发一系列机会性感染及肿瘤。李发枝教授根据艾滋病的临床特点,认为感染艾滋病病毒后脾气虚损是艾滋病发病的重要环节,气虚痰瘀是艾滋病发病发展演变的关键所在,而最终导致的元气的虚损是艾滋病得以发生发展的根本原因。在治疗时注重扶正祛邪相结合,治法上采取补中益气、养血化瘀、健脾滋阴等不同症候间的灵活运用。     

128颗隐裂牙的病因分析和临床治疗观察

目的探讨造成牙齿隐裂的影响因素及临床治疗方法。方法对患者的128颗隐裂牙进行临床观察。结果牙隐裂的好发年龄为35～60岁，其中男性多于女性；好发牙位为上颌第一磨牙；合力因素是隐裂牙发生的重要因素，牙尖斜面是隐裂牙发生的易感因素，牙齿本身因素是隐裂牙发生的内在因素。结论及时发现隐裂牙，采取恰当的方法，可取得较好的临床效果。     

The relationship between a deficit in attention switching and specific behaviours in Prader‐Willi syndrome

Background : We aimed to investigate the causes of phenotypic behaviours in Prader‐Willi syndrome (PWS). Interviews with carers of 46 children with PWS suggested that frequent temper outbursts and repetitive questions were related to a resistance to change. In a group comparison with FraX and typically developing children, PWS children showed a specific deficit in attention switching (direct assessment), which was correlated to informant scores of resistance to change and repetitive questions. We aimed to investigate neural correlates and hypothesized behavioural effects of the PWS deficit in attention switching. Method : Multiple single case experimental designs were employed with four individuals with PWS. Cognitive challenges placed demands on attention switching or controlled for these demands. Changes to routines or expectations were presented during controlled games, or imposed on participant’s natural environments, and compared to corresponding sessions when no changes were imposed. Behaviour was recorded and physiological arousal was estimated using heart rate measurements. Eight participants with PWS were compared to age and gender matched controls. Structural T1, T2 and diffusion weighted images were acquired in a Philips T3 MRI scanner. T2* weighted functional images were acquired in a block design (eight presentations of each block per participant) with alternating switching and non‐switching blocks. Results : In the single case experiments, significantly increased temper outburst related behaviours (p < 0.05) and arousal (decreased heart rate variability: p = 0.042) were shown in switching verses control challenges. Significantly increased temper outburst related behaviours were also shown when changes were imposed versus when no changes occurred (p < 0.03). Structural images suggest abnormalities in specific frontal regions in individuals with PWS and functional images revealed significant differences in switch‐related activation in individuals with PWS compared to controls. Conclusion : We propose a directional relationship between specific neural abnormalities, cognitive deficit and behaviour in PWS via particular environmental and physiological interactions.     

Evidence for a discrete behavioral phenotype in the oculocerebrorenal syndrome of lowe

The oculocerebrorenal syndrome of Lowe (OCRL) is an X-linked disorder characterized by congenital cataracts, cognitive impairment, and renal tubular dysfunction. Although there is a wide range of intellectual function in affected individuals, it is often compromised by a high prevalence of maladaptive behaviors, including tantrums, stubbornness, and stereotypy. Whether these behaviors simply reflect the multiple disabilities found in some developmentally impaired individuals with or without OCRL, or a specific genetically-determined behavioral phenotype of OCRL, is unknown. Controls were matched for sex, age, visual impairment, and adaptive functioning and compared with OCRL patients on three standardized measures of adaptive/maladaptive behaviors. Forty-three matched pairs of OCRL and control subjects were identified. Both groups were similar in communication, daily living, socialization, and motor skills, in socioeconomic status, and in measures of parental stress. Individuals with OCRL displayed significantly more severe maladaptive behaviors than control boys, as measured by the Vineland Adaptive Behavior Scales (VABS), with 41% of the difference between the two groups attributable to the diagnosis of OCRL. Twelve maladaptive behaviors measured on the VABS appeared more frequently in OCRL than in controls. Five of these 12 behaviors, i.e., temper tantrums, irritability, complex repetitive behaviors (stereotypy)/mannerisms, obsessions/unusual preoccupations, and negativism, were identified by discriminant function analysis to significantly distinguish between controls and OCRL individuals. The diagnosis of OCRL is associated with a behavioral phenotype consisting of temper tantrums, stereotypy, stubbornness, and obsessions/unusual preoccupations. This phenotype cannot be attributed solely to the visual, motor, and intellectual disabilities characteristic of OCRL, and may represent a specific effect of the OCRL gene on the central nervous system. © 1995 Wiley-Liss, Inc.

1 This article is a U.S. Government work and, as such, is in the public domain in the United States of America.

     

Practitioner Review: Definition,recognition, and treatment challenges of irritability in young people

Background

Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years.

Methods

In this review, we provide up‐to‐date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm.

Results

Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability.

Conclusions

Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure‐based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.