Michael F. Cataldo

The biological basis for self-injury in the mentally retarded

Abstract Self-injurious behavior has presented a clinical and academic challenge to both behavioral and biomedical researchers. Recent advances in biomedical research suggest a number of specific biological bases for self-injury. This research was reviewed with regard to the possibility that a specific biological explanation for self-injury could be advanced. Deficiencies in biochemicals necessary for normal brain functioning, inadequate neurological development of the central nervous system, isolation and pain related experiences early in development, altered neurological input particularly sensory irritation, neurological insensitivity to pain, and the bodys ability to produce opiate-like substances (endogenous opiates) in response to pain and injury all offer leads as to the biological basis of self-injurious behavior. No single explanation has been definitively proven as a cause for self-injury in the retarded. However, consideration of behavioral treatment approaches in combination with biological explanations, especially those related to the biochemistry of pain, may provide the opportunity for important breakthroughs in the understanding and successful elimination of self-injurious behavior.

Pediatric psychology in primary health care: Brief targeted therapy for recurrent abdominal pain *

Children with recurrent abdominal pain (RAP) are frequent users of medical care services, often seeking care for a variety of illnesses and symptoms. In a clinical replication series, we treated 16 children with RAP who were referred to a primary care-based pediatric psychology service. They received a multi-component targeted therapy, which included self-monitoring, limited parent attention, relaxation training, increased dietary fiber, and required school attendance. After treatment, improvement or resolution of pain symptoms was reported for 13 (81%) children, and school absences were significantly decreased. Medical care utilization significantly decreased after treatment, whereas a comparison group of untreated children with RAP showed no change in medical care visits over time. Brief targeted therapy delivered in a primary health care setting appeared to be effective in reducing a range of problems associated with RAP. A primary care service is an ideal setting for integrating behavioral medicine services into the health care system.

Biofeedback Treatment of Fecal Incontinence in Patients with Myelomeningocele

Approximately six hours of biofeedback training was given to eight fecally incontinent children with myelomeningocele in order to establish bowel control. Their ages ranged from five to 15 years. The patients were shown a polygraph tracing of the external anal sphincter while they were being encouraged voluntarily to contract the sphincter when the rectum was distended with progressively larger volumes of air in a balloon. Seven of the eight patients showed normal sensation for rectal distension.

Compliance and Correlated Problem Behavior in Children: Effects of Contingent and Noncontingent Reinforcement.

Analyses of response relationships offer the potential for designing treatment procedures that are more economical and entail less risk for misuse than many we currently employ. The present study investigated whether previous results indicating the reduction of problem behaviors by reinforcing compliance in fact occurred because of the contingent relationship between compliance and the presumed reinforcing events. A clinic analogue procedure consisting of a standard set of adult requests was employed in a multiple baseline design across subjects with three children receiving three conditions — no reinforcement, noncontingent reinforcement, and reinforcement contingent on compliance — and a fourth child receiving the first and third conditions to assess possible order effects. The data indicated that: (1) compliance covaried inversely with some, but not all, of the problem behaviors measured; (2) sustained covariation occurred only when reinforcement was contingent on compliance; (3) substantially large but transient increases in compliance and decreases in problem behavior during noncontingent reinforcement occurred for those children who initially demonstrated high compliance and low levels of aberrant behavior during baseline; and (4) the problem behaviors that inversely covaried with compliance were idiosyncratic across children. The results suggest that treatment procedures based on response relationship strategies should consider that childrens individual learning histories may determine which behaviors covary and the likelihood that large, initial changes can occur with noncontingent reinforcement.

Behavior analysis and intervention during hospitalization for brain trauma rehabilitation

Continued problematic behavior in children and adolescents after brain trauma is a major barrier to medical care, rehabilitation, and eventual independent living. The present study demonstrates the application of already well-developed behavior analysis techniques to the early posttrauma expression of behavior problems during hospital recovery. To satisfy concerns regarding both cost and individualized treatment, interventions were carried out primarily by regular hospital staff (nurses and therapists), medical record data were used to document gains, and time series, within subject designs were used to show experimental control. Four patients (three male and one female) ranging in age from 10 to 16 years, received intervention based on behavior analysis techniques, which reduced disruption and increased cooperation with therapy and medical care. Behavior analysis techniques will be relevant to future rehabilitation research to the extent that the posttrauma patients behavior is effected by environmental consequences as demonstrated here.

On the clinical relevance of animal models for the study of human mental retardation

Use of animal models can increase scientific understanding of and clinical/educational intervention possibilities for persons with mental retardation. Information gathered through such models has provided an important foundation for both theory and practice. Progress in understanding and ameliorating intellectual disability through animal modeling will be enhanced by efforts to increase the validity of the models. That is, the models must capture not merely important behavioral/cognitive processes per se, but also processes that may be especially impaired in intellectual disability. The authors reviewed criteria for determining that a given individual has an intellectual disability, selected examples of research on animal behavior that have contributed to effective prevention and treatment approaches, and successful approaches for modeling behavioral retardation. Animal models using behavioral measures based on characteristics that discriminate human mental retardation may prove to provide the most valid and clinically relevant approach.

Pediatric intensive care unit patients. Effects of play intervention on behavior.

The effects of a 20-min play intervention by a child life teacher on two observed behaviors were investigated in Pediatric Intensive Care Unit (PICU) patients at the Johns Hopkins Hospital Childrens Center. Eleven subjects, ranging in age from 2–13 years, were observed using a Preintervention—Intervention—Postintervention design with a 3-min time sampling technique to measure the change occurring when structured play activities were introduced into the PICU environment. Significant positive changes were noted between Preintervention and Intervention in (1) affect and (2) interaction with materials. In the Postintervention period, these behaviors fell close to Preintervention levels, suggesting that the positive changes were not maintained in the absence of the Intervention condition. The results indicate that while play intervention in the PICU environment can have beneficial effects on patients behavior, the effects of such intervention are short-lived. These data hold important implications for the staffing requirements needed to provide opportunities for the positive behavior changes to occur.

Considerations in the analysis and treatment of dietary effects on behavior: a case study.

Scientific and public interest in the effects of diet on behavior disorders has recently increased. This paper argues that (1) the experimental analysis of behavior offers an effective scientific methodology for assessing the effects of dietary substances on behavior problems, and that (2) such analysis permits behavioral consequences to be considered as an alternative treatment to dietary control. A case study of a 9-year-old retarded boy with autistic behaviors is presented. Suspected dietary substances were demonstrated not to be effective influences on the childs behavior, whereas a simple behavior modification program improved his problem behaviors. Also discussed are issues and problems which arise in research on dietary effects on behavior and in selection of effective and ethical treatments.

Assessment and modification of delusional speech in an 11-year-old child: A comparative analysis of behavior therapy and stimulant drug effects

Abstract A reversal design was utilized in which differential vs non-differential adult attention was made contingent upon the delusional speech of an 11-yr-old boy. Within this design, effects of verbalizing the contingency and the use of a pharmacological treatment were also studied. The results indicated that differential adult attention only to appropriate task related statements increased such statements while decreasing delusional speech, whereas non-differential attention to any type of statement resulted in a predominance of delusional speech. A trial of methylphenidate showed no difference relative to non-differential attention. Additionally, the results suggest that verbalizing the differential attention contingency may be an effective tactic for rapid behavior change. The results are discussed in relation to the necessity for comparing possible courses of treatment as a strategy for insuring effective treatment.

Behavioral/Environmental Considerations in Pediatric Inpatient Care

Behavioral pediatrics has typically emphasized two areas of interface between the behavioral sciences and pediatric medicine. One is the identification, treatment, and prevention of childhood behavior problems through routine clinic and well-child visits (Christophersen & Rapoff, 1979). The second is the use of behavioral procedures to correct primary medical problems and those secondary to particular medical conditions. For example, behavioral procedures have been demonstrated to be effective in reducing seizures (Cataldo, Russo, & Freeman, 1979; Zlutnick, Mayville, & Moffat, 1975), in the treatment of neuromuscular disorders (Cataldo & Bird, in press; Cataldo, Bird, & Cunningham, 1978), in treating fecal incontinence secondary to myelomeningocele (Whitehead, Parker, Masek, Cataldo, & Freeman, 1981) and in dealing with pediatric chronic pain (Varni, Bessman, Russo, & Cataldo, 1980).