Association for Behavior Analysis International

Biological interventions by medical professionals are often warranted for specific diagnoses, particularly when direct etiology is identified. However, with certain psychiatric disorders, etiology is not easily assessed or includes a combination of biological and behavioral variables. For example, children diagnosed with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) might have underlying infectious and inflammatory processes where simultaneous treatment of biological and behavioral symptoms are recommended (Thienemann, et al., 2017). Accurate treatment data are crucial to ensure adherence to medical and behavioral interventions to improve functioning and decrease suffering. However, due to the simultaneous treatment of bio-behavioral symptoms, accurate treatment data from medical and behavioral interventions are often difficult to progress monitor. In this presentation, we demonstrate ways to track changes in symptomatology in children diagnosed with PANDAS in response to biological and behavioral treatment strategies by a multidisciplinary team of professionals (e.g., behavior analysis, psychiatry, pediatrics, immunology). ABA-based data collection methods including scatterplot, multi-element designs, and function-based narratives were used to track intervention variables as well as changes in symptoms over time for 2 children diagnosed with PANDAS.

The relationship between sleep deprivation, irregularity of bedtime and waking time, and length of sleep onset latency and health risks has been shown in several studies (e.g., Luyster et al., 2012). In addition, sleep problems are widely recognized among Japanese university students (e.g., Steptoe et al., 2006). However, there are few intervention studies on sleep in non-clinical university students and few online intervention studies. In this study, we conducted an online workshop based on CBT-I and an intervention using graphical feedback of sleep in four university students and examined the effects using sleep diaries and questionnaires. The results showed that the sleep onset latency decreased in one participant during intervention and follow-up, but there were no effects of the intervention on bedtime/wake time, sleep onset/wake time, sleep duration, mid-wake, or subjective sleep quality in all participants, and the PSQI-J scores of two participants decreased before and after the study period. These results suggest that the intervention package in this study may improve sleep onset latency and insomnia tendency. In future studies, it will be necessary to individualize the intervention procedures, provide incentives for implementing the procedures, examine the effects of each intervention technique alone, and quantitatively measure sleep.

The Children Psychiatry Department at the Sheba Health Center offers a pioneering model of collaboration between Psychiatry and Applied Behavior Analysis. The health center also includes an Applied Behavior Analysis certification program. Patients are six to twelve years old children experiencing complex behavioral challenges requiring intensive and professional care. Among the challenges are self-injury, social and school difficulties, psychotic and medical issues. Children reside at the department for a few weeks up to three months. Staff include Psychiatrists, Nurses, Psychologists, Social Workers, Teachers, Speech Therapists, Behavior Analysts, Dieticians. The department hosts a school supervised by the Ministry of Education. It also enables students from the certification program to experience practicum within the department, beneficiary to both. The Behavioral program includes a “growth ladder” for each patient, based on a Token Economy system supporting target behaviors defined by the Psychiatrists. It also includes individual interventions such as functional communication training, differential reinforcement, and gradual exposure to frustrating triggers. The Behavioral model will be presented followed by key challenges related to its implementation.