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| CBM Monday Noon |
| Monday, May 25, 2015 |
| 12:00 PM–2:00 PM |
| Exhibit Hall C (CC) |
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| 23. Evaluation of a multielement assessment and behavioral training for pill-swallowing difficulties |
| Area: CBM; Domain: Applied Research |
| VALORI N. BERENDS (Seattle Children's Hospital - Autism Center), Danielle N. Dolezal (Seattle Children's Hospital - Autism Center), Amber Persons (Seattle Children's Hospital - Autism Center) |
| Abstract: Previous research demonstrated the effectiveness of a protocol for teaching pill swallowing to children with developmental disabilities (Slifer, 2014; Ghuman et al., 2004). We extended this research by conducting a multielement evaluation of pill size across measures of swallowing, sips of water, refusals and chewing to determine the most appropriate starting point for treatment. Once an appropriate pill size was identified, we implemented a positive reinforcement package including stimulus fading and differential reinforcement for pill-swallowing with one participant. The participant was a 16-year old male with diagnoses of epilepsy, autism, anxiety not otherwise specified, and disruptive behavior disorder. Pill sizes were evaluated in treatment using a multielement and reversal design across refusals, sips of water, chewing and both active and placebo “pills” swallowed. Performance across the dependent variables was used to determine next appropriate steps in treatment. Data show pill chewing until differential reinforcement was contingent on swallowing with no chewing rather than swallowing alone. Results indicate that the multielement assessment was successful in identifying the largest pill the adolescent could swallow with limited refusal and with which to begin the behavioral training. Treatment was terminated following success with active pills. |
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| 24. Discounting of Delayed Rewards in Humans With Neurological Diseases |
| Area: CBM; Domain: Applied Research |
| BARTLOMIEJ SWEBODZINSKI (University of Social Science and Humanities in Warsaw) |
| Abstract: The aim of this study is to answer the question whether focal damage within the cerebral cortex of different locations has an impact on the rate of discounting of delayed positive reinforcement. The pilot study was done in a sample of 26 patients with focal brain damage. Patients were divided into groups based on neuroimaging data. The study involved 14 women and 12 men. Patients were asked to choice between different amount of money, hypothetically received immediately or after a certain delay. The dependent variable was the subjective value of delayed reward. Independent variables were: location of neurological damage within the cerebral cortex (frontal lobe vs. other areas of the brain), the size of the reward (2000 PLN or 200 PLN) and the delay of the reward (three days, a week, a month, 3 months, 6 months, a year). A significant interaction was the damage location and size of the reward. The people with the frontal location of damage compared to people with damage in other areas of the brain, discounted bigger reward faster but slower the small one. Bigger rewards were discounted more slowly than smaller only in humans with injuries located not in the frontal lobe cortex. |
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| 25. The Therapist's Behavior and Its Relationship With User's Treatment Attendance |
| Area: CBM; Domain: Applied Research |
| JUDITH ELISA FERRER ALARCÓN (National Autonomous University of Mexico), Silvia Morales Chaine (UNAM) |
| Abstract: There are a significant proportion of drug users who do not finish your intervention. Often users leave the intervention before the first month of treatment, when they have not received the expected benefits with the procedures. Therapists behavior has influence in the users behavior. The aim of this study was to describe the relationship between the therapists behavior and users treatment attendance after a one session of brief counseling using motivational interviewing. We worked with 8 therapists (87.5 % female) aged 22 to 43 years old and 8 men aged 18 to 57 years old who used marijuana, cocaine or tobacco, at the public institution created to prevent drug abuse. We used a sequential behavioral coding system in motivational interviewing that includes 20 behavioral categories. We obtained a reliability of 0.83 through kappa index and we performed a sequential analysis. The results showed that 80% of users that received the brief counseling attended at one additional treatment session and therapists behaviors consistent with motivational interviewing were more likely to be followed by users behavior descriptive. By understanding the behavior performed by the therapist and his connection with users attendance we will hope foster the behaviors that increase adherence to treatment of users substance. |
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| 26. Behavioral Skills Training for Teaching Assertiveness in Condom Insistence for College Students |
| Area: CBM; Domain: Applied Research |
| SADIE L. LOVETT (Central Washington University), Megan McCulley (University of Washington) |
| Abstract: The Centers for Disease Control and Prevention (CDC) report that over 1.7 million people acquired a new sexually transmitted disease in 2011 (CDC, 2013d). Condom use can protect the user from exposure to sexually transmitted diseases; however, many people discontinue use of condoms because they lack the assertiveness skills to request a partner use a condom (e.g., Harvey et al., 2004). The current study used Behavioral Skills Training (BST) to teach assertiveness skills to three undergraduate students. A multiple probe design was used to evaluate the effects of BST on assertiveness. BST was delivered in individual sessions in a role-play format that included scenarios in which the participants were required to respond to a verbal request to initiate sex without a condom. Results indicate that BST was an effective for increasing assertiveness skills, and generalization was observed with novel scenarios. Results of a short post-training survey indicate that participants also evaluated the BST intervention positively. |
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| 27. A fading procedure reduces the number of impulsive choices in adolescents witnesses of family violence |
| Area: CBM; Domain: Applied Research |
| AGUSTIN JAIME NEGRETE CORTES CORTES (Universidad Autónoma de Baja California), Ariel Vite Sierra Sierra (Universidad Nacional de Mexico) |
| Abstract: The experience has an important role in the development of self-control. Human and animal studies have shown that it is possible to increase the self-control through exposure to choice contexts favoring the choice of the larger reinforcer if the delay of the larger reinforcer is gradually increased. This procedure is known as fading procedure of the delay (Mazur & Logue, 1978). Therefore, the aim of this study was to evaluate whether a treatment derived from this model is useful to develop self-control in a sample of adolescents witnesses of family violence with high scores of impulsive behavior assessed through manipulating dimensions of reinforcer such as Immediacy (I), Quality (Q ), Effort (E) and Rate of Reinforcement (R). Participants were 10 adolescents witnesses of family violence with ages between 14 and 17 years old, all high school students in Mexico city. The dimensions of reinforcer involved in impulsive behavior were identified through an initial assessment. Subsequently, the identified dimensions were subjected to fading procedure and finally were evaluated under the same conditions as in the initial evaluation. In general, the treatment increased the preference for those conditions where the gain was a higher quality reinforcer, despite it has a higher delay |
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| 28. An Evaluation of the Variables Associated with Weight Loss in Parent-Supported Weight Reduction Programs for Adolescents and Young Adults with Intellectual Disabilities |
| Area: CBM; Domain: Applied Research |
| GRETCHEN A. DITTRICH (Simmons College and E. K. Shriver Center at Univer), Richard K. Fleming (University of Massachusetts Boston), Carlos Salas (University of Massachusetts Boston), Barbara Fargnoli (E. K. Shriver Center at University of Massachusetts Medical School) |
| Abstract: Overweight and obesity are associated with an increase in health disorders, including heart disease, diabetes, hypertension, and some cancers. The prevalence of obesity is higher in individuals with intellectual disabilities than in the general population. Behavioral weight loss programs have been demonstrated to be effective in reducing weight in individuals with intellectual disabilities, yet it is unclear which components of the treatment packages influence weight loss. The current study retrospectively evaluated data collected during two randomized control trials consisting of parent-supported weight reduction intervention to determine variables associated with weight loss in adolescents and young adults with intellectual disabilities. Variables analyzed included treatment adherence (attendance, participation during sessions, answering weekly phone calls, setting goals, and monitoring), goal attainment, and step count. Data were analyzed using time series analysis to evaluate within-subject trends and aggregate data throughout the progression of the intervention, including change in adherence over time. Additionally, multiple regression analyses were used to analyze the individual effects of each variable on weight loss. Data were evaluated from two different weight loss programs, one program consisting of 10 weekly sessions, followed by four biweekly sessions, and two triweekly sessions (16 total sessions), and the second program consisted of 24 weekly sessions. For both programs, 1.5 hour sessions occurred in a group format with both parents and their children. The first 45 min of the session focused on nutrition education for both the parents and their children, and during the second 45 min of the session the group was separated, at which time the children completed activities related to nutrition and physical activity, while the parents were instructed on behavioral strategies (e.g., monitoring, reinforcement, behavioral contracting, stimulus control, and goal setting) to facilitate weight loss in their child. The current study is still ongoing; therefore data are forthcoming. Preliminary data suggest treatment adherence declined over time, and participants whose parents showed higher treatment adherence lost more weight. |
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| 29. Conceptualizing food preferences as rich-to-lean and lean-to-rich choices with children who self-feed |
| Area: CBM; Domain: Applied Research |
| GRACE CALVIN (Kennedy Krieger Institute), Julia N. Woods (Kennedy Krieger Institute), John C. Borrero (University of Maryland, Baltimore County), Carrie S. W. Borrero (Kennedy Krieger Institute) |
| Abstract: Pausing between responses occurs between preferred and non-preferred activities (Perone & Coutney, 1992). In the case of feeding, these pauses potentiate long and challenging meals for families of children with feeding disorders. The present study examined pause durations between bites of preferred and non-preferred foods among children with feeding disorders when children were given an opportunity to choose their transitions. Two children with feeding disorders were presented a full-plate containing preferred (rich) and non-preferred (lean) foods and data were examined to determine the average durations of pauses in acceptance when transitioning between foods. The data demonstrate that rich-rich transitions are associated with the shortest pause duration between bites, and rich-lean transitions are associated with the longest pause duration between bites. Children’s choices and responses during transitions between preferred and non-preferred foods have significant implications for feeding disorder interventions. Discerning ways to reduce pauses during meal-times can shorten the duration of meals and significantly improve the quality of meals for children with feeding disorders and their families. |
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| 30. An Evaluation of Different Magnitudes of Differential Negative Reinforcement in the Treatment of a Pediatric Feeding Disorder |
| Area: CBM; Domain: Applied Research |
| COURTNEY MAUZY (University of North Carolina Wilmington), Melanie H. Bachmeyer (University of North Carolina Wilmington), Billie J. Klein (University of North Carolina Wilmington), Jessica Keane (University of North Carolina at Wilmington), Natasha Chamberlain (University of North Carolina at Wilmington), Caitlin A. Kirkwood (University of North Carolina Wilmington) |
| Abstract: Given the role of negative reinforcement (escape from bites/drinks) in the maintenance of pediatric feeding problems and the effectiveness of escape extinction as treatment, it is surprising that little attention has been given to the effects of escape as reinforcement for appropriate mealtime behavior during treatment. Some applied studies have shown that reinforcement magnitude may influence responding (e.g., Trosclair-Lassere et al., 2008). Using a combined multi-element and reversal design, we examined the relative effects of different magnitudes of negative reinforcement (30-s or 150-s break) for appropriate mealtime behavior (mouth clean, a product measure of swallowing) with and without escape extinction to treat the liquid refusal of a child diagnosed with a feeding disorder. Interobserver agreement was conducted on 80% of sessions and was above 80%. Liquid consumption increased only when escape extinction was implemented. Neither magnitude of negative reinforcement combined with escape extinction resulted in differential treatment effects compared to escape extinction only. Potential areas for future research will be discussed. |
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| 31. Parent-Led Shaping for Adipsia and Plate A-Plate B for Food Selectivity in a Young Child |
| Area: CBM; Domain: Service Delivery |
| WHITNEY HARCLERODE (Penn State Hershey Medical Center), Shannan Lamparski (Penn State Harrisburg), Keith E. Williams (Penn State Hershey Medical Center) |
| Abstract: A two-year old child with typical development was referred for consumption of only baby food and yogurt mixed with water. His parents fed him these smooth foods by spoon. He refused to drink from a cup, bottle, or straw and consumed only liquids mixed with smooth foods. His table foods were limited to cheese balls, angel hair pasta, crackers, and pretzels. In the past, he drank from a bottle until the nipple broke and he refused all further liquids. Due to his reliance on watered-down food to meet his hydration needs, he was seen in an intensive outpatient feeding program for 11 days. This child was treated with a parent-led shaping procedure for his adipsia. His food selectivity was treated with Plate A-Plate B, which involves reinforcement of novel food consumption with preferred foods. Results showed the stimulus fading procedure increased acceptance and consumption of liquids from a cup. In three baseline sessions, he consumed no liquids for his parents. For the last three meals of treatment, his average per meal consumption for his parents exceeded five ounces. Using the Plate A-Plate B intervention, his consumption of novel table foods increased from 0 to 36. |
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| 32. Profile of a sample of obese and overweight children |
| Area: CBM; Domain: Applied Research |
| ARIEL VITE SIERRA SIERRA (Universidad Nacional Autónoma de Mexico), Tania Romero (Universidad Nacional Autónoma de México), Geraldine Zúñiga (Universidad Nacional Autónoma de México), Michelle Mora (Universidad Nacional Autónoma de México) |
| Abstract: Childhood obesity, especially in adolescence is a strong predictor of obesity in adulthood and is now considered public health problem in clear ascent. In fact, it is the most common childhood disorder literature shows as the psychological characteristics have a significant weight in the etiology and maintenance obesity, as well as in their treatment, both adults and children. But must take into account that the relationship between obesity and psychological characteristics is complex and multifactorial. However it seems that the literature indicates a psychological profile associated with childhood obesity and overweight; however, data not totally conclusive and, some cases, conflicting. Therefore the aim of this study was to explore the profile of overweight/obese children, in comparison with a group of non-overweight/obese children. A sample of 40 children (8 to 10 years-old) was evaluated for the presence of the following psychological variables: Self-concept, Body Perception, Self-efficacy to Exercise, Anxiety and Impulsivity. The sample consisted of 20 overweight/obese children and 20 normal-weight children. Compared to the children with normal weight, the overweight/obese children presented minor self-efficacy to exercise and higher levels of anxiety. The variable which best discriminated between the groups was impulsivity. The results support previous studies that have shown the presence of impulsivity in obese children, and the existence of differential psychological features. |
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| 33. Escape Baseline: An Efficient and Sufficient Means to Assess the Function of Food Refusal Behavior |
| Area: CBM; Domain: Applied Research |
| GABRIEL SCHNERCH (Marcus Autism Center), Roseanne S Lesack (Emory University School of Medicine), Camila Salvador (Marcus Autism Center), William G. Sharp (Emory University School of Medicine) |
| Abstract: Applied behavior analytic methods have proven effective in treating food refusal, and best practice dictates that the function of a behavior should be assessed prior to treatment. In behavior analysis, functional analysis is the gold standard for determining the likely function of inappropriate behaviors. However, single component analyses of function are more efficient, and in some cases, may be adequate to provide quantitative support for a hypothesis of the function of a behavior. In addition, prior literature suggests that escape from demands is often the primary function in cases involving food refusal. Participants for this retrospective chart review included children receiving treatment at a day treatment program from November 2013 to November 2014. Preliminary analyses via visual inspection of graphed data (i.e., rapid acceptance of bites and inappropriate mealtime behaviors) suggests that food refusal is a category of behavior in which a single component analysis, namely the “escape baseline”, may be a sufficient assessment of the function. It is also more efficient in terms of time and labor than conducting a full functional analysis. Future research experimentally comparing the results of only the escape baseline condition to a full functional analysis would be warranted to improve confidence in the method. |
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| 34. Treating Food Refusal for a Client with Food Allergies and Eosinophilic Esophagitis |
| Area: CBM; Domain: Service Delivery |
| LINDA-MAI NGUYEN (Marcus Autism Center), Roseanne S Lesack (Emory University School of Medicine), William G. Sharp (Emory University School of Medicine) |
| Abstract: This case study demonstrates considerations taken at multiple stages in treating food refusal with a client presenting with multiple food allergies and eosinophilic esophagitis. Adam, a 7-year-old male with autism spectrum disorder and developmental delay, was admitted to a day treatment program for total food refusal and formula dependence. His medical history also included gastroesophageal reflux disease, eczema, and multiple nutrient and vitamin deficiencies. At the time of admission, his diet consisted solely of whole milk ( identified as one of his food allergens) and he refused all solid foods. Treatment involved systematically introducing four foods selected based on a negative skin prick test response. Behavioral elements involved in treatment included non-removal of the spoon, noncontingent reinforcement, and bolus fading. During the course of admission, there was a significant increase in rapid acceptance and mouth cleans, coinciding with a decrease in combined inappropriate behaviors. Feeding treatments based on the principles of applied behavior analysis have been shown to be highly effective at treating food refusal; however, this case demonstrates key treatment considerations when food allergies are a major, life-threatening concern. |
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