Deborah A. Napolitano

Increasing Response Diversity in Children with Autism.

Repetitive and invariant behavior is a diagnostic feature of autism. We implemented a lag reinforcement schedule to increase response diversity for 6 participants with autism aged 6 to 10 years, 4 of whom also received prompting plus additional training. These procedures appeared to increase the variety of building-block structures, demonstrating that an intervention that includes differential reinforcement can increase response diversity for children with an autism spectrum disorder.

Behavioral Interventions to Reduce the Pica of Persons with Developmental Disabilities

The consumption of nonfood items (i. e., pica) frequently occurs in persons with developmental disabilities. Pica may result in the puncture or blockage of the digestive tract, infestation by gastrointestinal parasites, and can interfere with an individual’s daily learning, occupational performance, and quality of life. Twenty-six published studies have examined the efficacy of behavioral-intervention packages (e. g., differential reinforcement of other behavior, noncontingent attention, or overcorrection) on the pica of persons with developmental disabilities. This article reviews those studies and discusses the effectiveness, generality, and acceptability of the various intervention packages used to reduce pica. Additionally, this article highlights the recent clinical advancements that have been made in the treatment of the pica of persons with developmental disabilities.

Effects of Risperidone on Aberrant Behavior in Persons With Developmental Disabilities: II. Social Validity Measures

Consumer satisfaction and social validity were measured during a double-blind, placebo-controlled evaluation of the atypical neuroleptic risperidone in treating severe aberrant behavior of persons with developmental disabilities. First, a satisfaction survey was completed after a medication trial by each participants caregiver. Results showed that 100% of the caregivers felt that participation was a positive experience for themselves and participants. Second, 52 community members viewed videotapes of 5 participants during a clinical interview when they were taking either placebo or risperidone. Raters also indicated that when on the medication, participants displayed fewer aberrant behaviors, were less irritable, in a better mood, and were more responsive to their environment.

Multimodal evaluation of risperidone for destructive behavior: functional analysis, direct observations, rating scales, and psychiatric impressions.

Risperidone, an atypical neuroleptic, has become a popular option for treating destructive behaviors of persons with developmental disabilities. A few studies have been conducted that evaluate the effects of risperidone on destructive behavior; however, none of these studies have combined objective measures with rating scales to evaluate the effects of risperidone on destructive behavior across home and clinical settings. This study evaluated the wide range of effects of risperidone on destructive behavior of 2 persons with developmental disabilities using weekly functional analysis sessions, daily observations, hourly home data, weekly rating scales, and monthly psychiatric impressions. Results indicate that risperidone does decrease destructive behavior and that, for the most part, all of the various measures yielded similar results.

Drug-behavior interactions in persons with mental retardation and developmental disabilities

Treatment for aberrant behavior in persons diagnosed with developmental disabilities typically involves either behavioral interventions or medication. Often, the treatment is a combination of the two. Schroeder and coworkers (Schroeder et al. [1983] Adv Learn Behav Disabil 2:179–225) outlined criteria for the evaluation of the combination of behavioral and drug interventions in persons with developmental disabilities. A review of the research that examined the combination of drug and behavior interactions since 1983, using the Schroeder et al. criteria, is provided. An evaluation of research since 1983 that examined medication effects on multiple dependent measures and between multiple medications, using the criteria for medication research by Sprague and Werry (Sprague and Werry [1971] Int Rev Res Ment Retard vol. 5) is also provided. Additionally, the final section provides a list of recommendations and criteria for practitioners and researchers when conducting or evaluating research designed to examine medication effects on multiple variables in persons with developmental disabilities. MRDD Research Reviews 1999;5:322–334.

Measurement of problem behaviour during medication evaluations

BACKGROUND The focus of this review is on methods that are currently being used to evaluate the behavioural effects of medication for individuals with intellectual disabilities. First we describe what has been identified as the ideal criteria for conducting clinical trials and how these criteria may be adapted to do less controlled evaluations. The central theme is a review of the biological measures (e.g. labs, drug levels), behavioural rating scales and direct observation measures that are often used to evaluate medication effects. Issues related to how the side effects of medication can affect behaviour will also be discussed. CONCLUSION The importance of encouraging communication and collaboration across all systems of care and the use of socially valid measures are discussed.

Perceptions of Body Image by Persons with Prader-Willi Syndrome and Their Parents.

Prader-Willi syndrome is a genetic disorder characterized by obesity. The Figure Rating Scale (Stunkard, Sorensen, & Schulsinger, 1983) was completed by 43 individuals with this syndrome to determine their level of dissatisfaction with their body. Their parents also completed this scale regarding their child to determine whether they were dissatisfied with their childs body status. Results showed that individuals with Prader-Willi syndrome were dissatisfied with their body. Parents also were dissatisfied with their childs body. Results of this study demonstrate that the responses of persons with Prader-Willi syndrome on the Figure Rating Scale show significant discrepancies between how they think they look and how they wished they looked.

The Role of Functional Assessment in Treatment Planning

Treatment planning to reduce challenging behavior (e.g., aggression and property destruction) can be complex and requires a prescriptive interprofessional team-based approach. As with other problems that interfere with an individual’s quality of life, such as health issues, the best course of treatment is one that accurately assesses the problem, leads to effective treatment for the issue of concern, and is empirically supported. This is especially important when treating individuals who display problem behavior which frequently interfere with their opportunities to learn and to live and be educated in less-restrictive settings (Matson, Mayville, & Laud, 2003). The utility of functional behavior assessments (FBAs) and functional analyses (FAs) in the identification of the specific function or purpose of challenging behavior has been embraced commonly by persons charged with supporting individuals who display challenging behavior (e.g., behavior analysts and educators). This is demonstrated by the laws requiring FBAs be conducted when individuals are struggling in educational environments (Individuals with Disabilities Education Improvement Act, 2004) and the belief that the assessments conducted should result in the development of interventions that help preserve the child’s placement in the least restrictive appropriate educational setting. The utility of these assessments has been repeatedly demonstrated in the published literature (e.g., Derby et al., 1992; Iwata, Dorsey, Slifer, Bauman, & Richman, 1994; Kennedy & Souza, 1995; Kern, Childs, Dunlap, Clarke & Falk, 1994; McCord, Thompson, & Iwata, 2001; Ellingson, Miltenberger, Stricker, Galensky, & Garlinghouse, 2000). Several excellent reviews of this extensive literature have been conducted and have independently identified functional analysis and assessment as best practice (e.g., Carr, 1994; Hanley, Iwata, & McCord, 2003).