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| Behavior Analysis and Intervention for Sleep and Pulmonary Disorders in Patients with Developmental Disabilities |
| Monday, May 31, 2004 |
| 3:00 PM–4:20 PM |
| Conference Room 3 |
| Area: CBM/DDA; Domain: Applied Research |
| Chair: Keith J. Slifer (Kennedy Krieger Institute) |
| Abstract: . |
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| Behavioral Intervention to Increase Compliance with the Electroencephalographic (EEG) Procedures |
| KEITH J. SLIFER (Kennedy Krieger Institute), Kristin T. Avis (Kennedy Krieger Institute), Alisa B. Bahl (Kennedy Krieger Institute), Suzanne Busby (Kennedy Krieger Institute), Jessica Gibson (Kennedy Krieger Institute), Urther Njordick (Kennedy Krieger Institute) |
| Abstract: Electroencephalographic (BEG) tests are often needed to diagnose seizure and other neurological disorders but the test may be distressing to children. The EEG procedure requires that children tolerate application of paste and sensors to their head and to inhibjt head and body motion. Behavioral distress often prevents successful EEG testing. Use of restraint, sedation, or general anesthesia are contraindicated because they would alter the test results. Behavior analysis can be used to teach children to cooperate with EEG procedures. Data are presented for pediatric patients with medical or developmental disabilities. All patients exhibited high levels o[behavioral distress when initial attempts to complete the EEG procedure were made. The behaviors required to complete an BEG procedure were task analyzed into a series of steps. A desensitization approach was used to gradually introduce each child to the equipment and to increase their tolerance of the procedures. Preferred activities were used to provide distraction from nonpreferred stimulation from sensor application and for differential reinforcement of compliance. Compliance was increased to 100% of the task analysis steps and behavioral distress was decreased to low levels. Results support the benefit of using behavioral training to obtain EEG results on young and developmentally disabled children. |
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| Graduated Exposure and Blocking Procedures used to Desensitize Children to I Equipment for Sleep Studies |
| GERI RUFFIN (Kennedy Krieger Institute), Heather Schonbachler (Kennedy Krieger Institute), Iser Guillermo DeLeon (Kennedy Krieger Institute), SungWoo Kahng (Kennedy Krieger Institute), Kristin T. Avis (Kennedy Krieger Institute) |
| Abstract: Two patients admitted to an inpatient facility were required to participate in a sleep study to measure the severity of sleep apnea. Both were reported to display avoidant movement and equipment removal when completing simple medical procedures. The following equipment was required to complete the study: EEG stickers, EKG leads, 2 Velcro bands, a pulse-oximeter and a nasal cannula. In baseline, each type of equipment was presented with pre-specified steps in place in a pre-determined order. Removing materials resulted in escape from that particular equipment and the therapist proceeded to the next equipment. For patient I, the intervention consisted of continuous access to a preferred item and response blocking along with graduated exposure to equipment, which yielded a 51 % increase in the duration of wearing all equipment. In patient 2, reinforcement-based components were proven ineffective. Thus, the intervention consisted of graduated exposure and response blocking which yielded a 70% increase. These interventions were generalized to the actual sleep study successfully and sufficient data were collected to determine the nature of their breathing patterns overnight. Two independent observers collected data of patients 1 and 2 for 71 % and 60% of sessions, with 89% and 91 % exact agreement coefficients, respectively. |
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| Increasing Patient Compliance with Supportive Respiratory Devices Prescribed for Obstructive Sleep Apnea |
| GINA WERTALIK (Kennedy Krieger Institute), Ethan Benore (Kennedy Krieger Institute), Jessica Gibson (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute) |
| Abstract: Obstructive sleep apnea (OSA) is a relatively prevalent problem in individuals with obesity. One of the most widely prescribed treatments for OSA is the use of Supportive Respiratory Devices (SRD) during sleep. Data will be presented for four patients requiring SRD as part of their medical regimen. Individualized treatment protocols included stimulus fading for desensitization to respiratory equipment, shaping through differential positive reinforcement, response cost for non-compliance, and prompting consistent sleep routines. Treatment effects were measured by completion of steps in a task analysis, compliance durations for wearing SRD, and observed behavioral distress ratings. Idiosyncratic barriers to treatment will be discussed. Overall, behavioral interventions increased compliance with SRD in a diverse group of patients and across settings; however continued research is needed to address barriers to treatment and maintenance of treatment effects |
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| Assessing and Treating Disorders of Sleep Initiation and Maintenance |
| KRISTIN T. AVIS (Kennedy Krieger Institute), Keith J. Slifer (Kennedy Krieger Institute) |
| Abstract: Parents often complain that their child has difficulty initiating sleep or is exhibiting disturbed sleep- The impact of sleep difficulties on children's attention, behavior, and development has been documented by research. Behavioral interventions are widely recommended to address bedtime resistance, frequent night waking, difficulty initiating sleep, and parasomnias. Behavioral assessment can identify specific environmental variables contributing to sleep disturbance or difficulties in sleep initiation. Behavioral treatment approaches often include manipulation of the environment to promote sleep onset, requiring the individual to engage in behaviors that improve bedtime and sleep related family routines (e.g.changing parental behavior at bedtime and during the night). Although behavioral interventions are widely recommended by clinicians, surprisingly few studies exist to document the efficacy of behavioral interventions to improve sleep in children. Data are presented on a series of children with sleep disorders of initiation and/or maintenance who were referred to a pediatric psychology outpatient clinic. Using AB and multiple baseline designs, data indicate a reduction in the frequency of night wakings, time to sleep onset, and frequency of parasomnias as well as an increase in total sleep time. Results provide empirical support for the use of behavioral interventions in these types of childhood sleep disorders. |
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