Peter Sturmey

Behavioral Treatment of Challenging Behaviors in Individuals with Mild Mental Retardation: Meta-Analysis of Single-Subject Research.

A meta-analytic study on effectiveness of behavioral and psychotherapeutic treatments for challenging behaviors in individuals with mild mental retardation is reported. Eighty articles were examined. For each comparison, several study variables and two effect sizes (percentage of nonoverlapping data-PND and percentage of zero data-PZD) were evaluated (Ms = 75% and 35%, respectively). Studies in which experimental designs and methods of experimental functional analysis were used had significantly larger PNDs than those with AB designs and descriptive methods, respectively. Functional analysis, reliability of recording, generalization, and internally valid designs resulted in larger PZDs. We found that behavioral interventions for challenging behaviors are effective with people with mild mental retardation.

Behavioral Activation Is an Evidence-Based Treatment for Depression.

Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier randomized control trial. Behavioral activation was consistently superior to wait list and treatment as usual control groups. Effect sizes were not different from cognitive behavior therapy or cognitive therapy, both post-treatment and at follow-up. Indeed, behavioral activation may be more effective than cognitive therapy and cognitive behavior therapy in terms of lower dropout. Behavioral activation, like cognitive behavior therapy, may be superior to paroxitine because it results in less relapse and recurrence, may be substantially cheaper, and does not have risks of pharmacotherapy. There is some evidence that behavioral activation may also be useful with some people for whom cognitive and cognitive-behavior therapy is less effective, such as those with severe, lifelong depression, people with substance abuse and people with dementia and severe depression. There is now sufficient evidence to conclude that behavioral activation is an evidence-based therapy.

Forensic Case Formulation

Formulation is the process or product of gathering and integrating diverse information to develop a concise account of the nature and etiology of the problems affecting a persons mental health to guide idiographic treatment design and other decision-making. Formulation is a core competency in mental health practice, including forensic mental health; however, there is no agreement concerning the details of how it should be done or how to evaluate it, either generally or more specifically with respect to forensic mental health. The purpose of this paper is to raise specific issues in the practice and evaluation of forensic case formulation, and so enhance the profile of this important area of work. In this paper, we (1) define case formulation and describe its key features, (2) specify criteria for evaluating case formulation, and (3) address challenges in forensic practice, with suggestions for advancing practice through research. We conclude with a proposed research agenda that we hope will encourage and promote activity in this important area.

EQUIVALENCE CLASS FORMATION: A METHOD FOR TEACHING STATISTICAL INTERACTIONS

Many students struggle with statistical concepts such as interaction. In an experimental group, participants took a paper-and-pencil test and then were given training to establish equivalent classes containing four different statistical interactions. All participants formed the equivalence classes and showed maintenance when probes contained novel negative exemplars. Thereafter, participants took a second paper-and-pencil test. Participants in the control group received two versions of the paper-and-pencil test without equivalence-based instruction. All participants in the experimental group showed increased paper-and-pencil test scores after forming the interaction-indicative equivalence classes. Class-indicative responding also generalized to novel exemplars and the novel question format used in the paper-and-pencil test. Test scores did not change with repetition for control group participants. Implications for behavioral diagnostics and teaching technology are discussed.

The effect of choice-making opportunities during activity schedules on task engagement of adults with autism.

Increasing choice and participation by adults with autism spectrum disorders is an important, but neglected, aspect of research and services. This study evaluated the effects of choice-making opportunities, embedded within activity schedules, and contingent praise on the engagement of three adults with autism in a community vocational setting. In the baseline condition, staff assigned the order of the tasks. In the Choice condition and Maintenance phases, the participants chose the order of tasks that supervisors assigned to them. They made their own activity schedules by writing down the order of their tasks for that morning. Social praise was provided contingent on the participants task completion. The same tasks were used in baseline, intervention, and maintenance phases. During the Choice and Maintenance conditions, client engagement was substantially higher than baseline for all three participants. Increasing choicemaking opportunities within activity schedules was an effective and socially acceptable way to increase choice and engagement in adults with autism.

THE EFFECTS OF BEHAVIORAL SKILLS TRAINING ON MAND TRAINING BY STAFF AND UNPROMPTED VOCAL MANDS BY CHILDREN

We evaluated the effects of a training package, including instructions, modeling, rehearsal, and feedback, for training staff members to conduct mand training with children. Experimenters collected data on staff performance on each step of a task analysis of mand training and on unprompted child vocal mands. Training resulted in increases in staff performance in mand training and in unprompted mands by children. We observed replication of these effects across settings for all staff and for 3 of the children.

Social validation data on three methods of physical restraint: views of consumers, staff and students

The use and evaluation of restraint methods with people with mental retardation is a continuing area of concern. Twenty-four undergraduate students, 21 residential care staff and 18 service-users from community settings rated videotapes of three physical restraint procedures. Two of the methods involved restraining an individual on the floor and a third method involved restraining an individual in a chair. Participants answered two open-ended questions to rate the methods of restraint and rated the methods on a 5-point scale of satisfaction [J. Ment. Defic. Res. 30 (1986) 369]. Participants also rated the three restraint methods by a forced-choice comparison. Restraint was rated negatively by all participants. However, both the satisfaction ratings and the forced-choice methods rated the chair method of restraint as most acceptable all three groups of participants. Consumers rated restraint more negatively than other groups. Restraint was evaluated negatively by all three groups, but the chair method was rated the least worst.

Analog baselines: a critical review of the methodology.

Analog baselines are an experimental methodology for identifying the functions of maladaptive behavior in the naturally occurring environment (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982; Iwata et al., 1994). This article identifies a number of potential limitations in this methodology. These include: (a) procedural problems inherent in the use of multielement designs, (b) the fidelity of analog baseline design conditions, (c) the relation of the analog conditions to the naturally occurring environment, (d) a narrow analysis of behavior limited by an implicit adherence to an ABC model of behavior, (e) a limited acknowledgement of multifunction and idiosyncratically motivated behaviors, (f) problems in the definition of response classes, and (g) difficulties in the use of analog baselines to design interventions. Future research should attend to three main questions. First, the convergent validity of different assessment methodologies, including analog baselines, should be evaluated. Future research should attend to procedures that can integrate the entire clinical process of referral, identifying the functions of the target behavior, including other methods of identifying the functions of behavior, treatment design, and implementation. Second, assessment failures could be examined carefully to identify ways of developing this methodology further. Third, the process of designing an intervention depends upon input from many sources of information. The use of analog baselines will be enhanced by a greater understanding of the process of clinical decision making.

Schedule-Induced and Operant Mechanisms that Influence Response Variability: A Review and Implications for Future Investigations.

Response variability, a fundamental characteristic of behavior, may be in some cases an induced effect of reinforcement schedules. Research on schedule-induced response variability has shown that continuous reinforcement results in less variability than intermittent reinforcement schedules. Studies on the effects of intermittency of reinforcement, periodicity of reinforcement, and type of schedule have resulted in mixed findings. Contingencies have also been arranged to directly influence operant response variability. These include lag reinforcement schedules, differential reinforcement of novel behavior, differential reinforcement of less frequent behavior, and percentile reinforcement schedules. These procedures are discussed in terms of practicality and implications for use in applied settings. Contingencies and treatment packages that indirectly influence response variability are addressed in terms of response allocation, response generalization, and response covariation. Studies on the effects of a variety of other variables on response variability are also reported, such as levels of food deprivation and drugs. Finally, directions for applied research in response variability are suggested.

Challenging Behaviors Should Not Be Considered Depressive Equivalents in Individuals with Intellectual Disabilities. II. A Replication Study.

Previous research has proposed behavioral equivalents for depression, but evidence for behavioral equivalents has been contradictory. The relationship between a measure of depression and several proposed behavioral equivalents of depression was assessed in 693 adults living in a large residential setting. Most were adults with severe or profound intellectual disability. The frequency of language-based measures of depression was very low. A scale to assess depression was constructed based on an item analysis of a larger pool of items. Both item and factor analysis and correlations between scores on the depression scale and individual maladaptive behavior items showed little or no relationship between proposed behavioral equivalents and depression. No support was found for behavioral equivalents of depression. This replicated the findings of Tsiouris, Mann, Patti, and Sturmey (2003). Practitioners are cautioned against using maladaptive behaviors as evidence of depression in people with severe or profound intellectual disabilities.