R. Matthew Reese

Effects of risperidone on Aberrant behavior of persons with developmental disabilities: I. A double-blind crossover study using multiple measures

The efficacy of the atypical antipsychotic risperidone was evaluated in the treatment of aberrant behavior (e.g., aggression, self-injury) in 20 individuals with developmental disabilities. A double-blind, crossover design was used to compare risperidone with placebo in a 22-week trial with a 6-month follow-up phase. Based on a 50% reduction in mean Aberrant Behavior Checklist--Community total scores, 50% of the participants were identified as responders. Naturalistic observations of a subset of five individuals showed that for 4 out of 5 participants, risperidone was effective in reducing aberrant behavior. Side effects included weight gain (84% of participants) and sedation (40% of participants). The advantages of conducting a comprehensive analysis of the effects of medication on aberrant behavior are discussed.

Effects of risperidone on destructive behavior of persons with developmental disabilities: III. Functional analysis.

Functional analyses were conducted during a double-blind, placebo-controlled study of the atypical antipsychotic medication risperidone with 13 individuals. Risperidone was effective in reducing destructive behavior (compared to placebo) for 10 participants. For 7 of these responders, an undifferentiated pattern of responding occurred across their baseline functional analysis conditions (i.e., a similar rate of responding across conditions), and risperidone treatment produced nonspecific reductions of their destructive behavior across functional analysis conditions. For the remaining 3 responders, a differentiated pattern of responding occurred across their baseline functional analysis conditions (i.e., an elevated rate of responding occurred in a specific condition), and risperidone treatment produced function-specific reductions of their destructive behavior.

Brief report: reliability and validity of instruments for assessing psychotropic medication effects on self-injurious behavior in mental retardation

Treatment of self-injurious behavior (SIB), a devastating behavior disorder among individuals with severe/profound retardation and in autism, has become the target of renewed interest. Prevalence estimates vary greatly depending on circumstances of the respective studies (Rojahn, 1994), but a prudent estimate would be that SIB occurs in approximately 5 to 10% of the population with mental retardation, and in about twice as many among persons with autism. Chronic severe SIB has been found to be extremely difficult to treat. So far the most successful approach has been the behavioral technology based on operant principles of learning. The behavioral technology, how-

Risk Factors for Self-Injury, Aggression, and Stereotyped Behavior Among Young Children At Risk for Intellectual and Developmental Disabilities

Before the 1990s, research on the early identification and prevention of severe behavior disorders (SBDs), such as aggression, self-injury, and stereotyped behavior, among young children with intellectual and developmental disabilities (IDD), was mostly done with children 3 years or older. More recent work suggests that signs of SBDs may occur as early as 6 months in some infants. The present study combined a cross-sectional and longitudinal approach to examine SBDs in 180 young children aged 4-48 months recruited through mass screening, then receiving an interdisciplinary evaluation and six-month follow-ups for one year. Twelve potential risk factors related to SBDs were examined. Eight of these risk factors, including age, gender, diagnosis, intellectual and communication levels, visual impairment, parent education, family income, were differentially related to scores for Aggression, SIB, and Stereotyped Behavior subscales on the Behavior Problems Inventory (BPI-01) at initial interdisciplinary evaluation. BPI-01 scores decreased over the year for 57% of the children and increased for 43%. The amount of decrease on each BPI-01 subscale varied with age, gender, and diagnosis.

Reducing agitated—Disruptive behavior of mentally retarded residents of community group homes: The role of self-recording and peer-prompted self-recording

Abstract Agitated—disruptive behavior such as cursing, hitting, kicking, throwing objects, and verbal threats from three mentally retarded residents From community group homes was reduced using procedures that included a self-recorded DRO, point fines for agitated—disruptive behavior, social skills training, and relaxation training. The agitated-disruptive behavior of all three subjects was markedly reduced as a result of the use of these procedures in combination. Further, with all subjects, the self-recorded DRO appeared to be critical to the effectiveness of the treatment program. Although subjects did not self-record accurately when they displayed agitated—disruptive behavior, the self-recording appeared to be effective in recruiting social approval from others in the environment when a specified period of time had passed without the occurence of agitated—disruptive behavior.

Reducing Disruptive Behavior of a Group-Home Resident with Autism and Mental Retardation.

A treatment package consisting of a DRO procedure, token fines, and prompted relaxation was used to reduce the agitated-disruptive behavior of a person with autism and mental retardation living in a community group home. The agitated-disruptive behaviors (cursing, hitting, kicking, throwing objects, and verbal threats) were measured during three different activities in a group home. The baseline rates of the agitated-disruptive behavior during one of these activities was relatively low, during another was moderate, and during the third was high. DRO procedures were partially implemented by a peer with Down syndrome and mental retardation during a portion of the study. Effects of the DRO procedures were as follows: During each activity an initial reduction of agitated-disruptive behavior was dependent on choosing an appropriate DRO interval, with shorter DRO intervals required during activities in which the baseline rates of the agitated-disruptive behavior were higher. Once shorter DRO intervals had been used to reduce agitated-disruptive behavior, longer DRO intervals were effective in maintaining those reductions. Reductions were maintained for up to 6 months.

Evidence for alterations in stimulatory G proteins and oxytocin levels in children with autism.

The neurotransmitter oxytocin plays an important role in social affiliation. Low oxytocin levels and defects in the oxytocin receptor have been reported in childhood autism. However, little is known about oxytocins post-receptor signaling pathways in autism. Oxytocin signals via stimulatory and inhibitory G proteins. c-fos mRNA expression has been used as a marker of OT signaling as well as of G protein signaling. Herein, we hypothesized that oxytocin and its signaling pathways would be altered in children with autism. We measured plasma oxytocin levels by ELISA, G-protein and c-fos mRNA by PCR, and G proteins by immunoblot in cultured peripheral blood mononuclear cells (PBMCs) in children with autism and in age-matched controls. Males with autism displayed elevated oxytocin levels compared to controls (p<0.05). Children with autism displayed significantly higher mRNA for stimulatory G proteins compared to controls (p<0.05). Oxytocin levels correlated strongly positively with c-fos mRNA levels, but only in control participants (p<0.01). Oxytocin, G-protein, and c-fos mRNA levels correlated inversely with measures of social and emotional behaviors, but only in control participants. These data suggest that children with autism may exhibit a dysregulation in oxytocin and/or its signaling pathways.

Mass Screening for Severe Problem Behavior among Infants and Toddlers In Peru.

Severe behavior problems among people with intellectual and developmental disabilities (IDD) are a major barrier to integration in the community. Recent research suggests that these behaviors often begin very early in life and might be prevented by early identification and intervention (Rojahn, Schroeder, & Hoch, 2008). The current article presents a method of mass screening for early signs of severe behavior problems among infants and toddlers in Peru. A Parental Concerns Questionnaire (PCQ), which asks 15 questions, each related to a risk factor for severe behavior problems, based on past research on IDD, was used by veteran parents to interview 341 new parents who had been solicited by TV, radio, and public service announcements across the country. Of these, 262 were recruited and enrolled in a longitudinal study in which they will be followed for 12 months to see if at-risk children actually will develop severe behavior problems. An extensive initial interdisciplinary evaluation was given to each child. Consumer satisfaction questionnaires were given to the parents as to their attitude toward the screening method. Data from the Interdisciplinary Evaluations of the sample suggest a very high hit rate (96%) by the screening instrument (PCQ). Consumer satisfaction was 98%, suggesting that the method was tolerated well by parents. The PCQ is a brief and efficient method to screen infants and toddlers at risk for severe behavior problems. The data also suggest that parents suspect these problems at a very early age. Early intervention thus seems a feasible strategy to intervene before these problems become deeply ingrained as children develop.

Biobehavior Analysis of Self-Injurious Behavior in a Person with Profound Handicaps

Two studies investigated self-injurious behavior (SIB) in a man with profound handicaps. Study 1 examined the effects of contextual variables on the rate of SIB during differing environmental conditions and behavioral states such as drowsy, quiet alert, active alert, agitated/crying. Results indicated that the rate of SIB varied depending on contextual conditions and behavioral state. The results also suggested that the function of SIB changed depending on the behavior state of the individual. Study 2 examined the effects of a treatment program that involved manipulating the environment depending on behavioral states, and then adding medication to the treatment plan. Results indicated that the treatment plan was effective in reducing self-injurious behavior and that the percentage of time spent in alert states increased when the treatment plan was implemented. Both SIB and behavioral state were positively affected when Fluphenazine was added to the treatment plan.

Educability: Public Policy and the Role of Research.

Values rather than science are often unrecognized as an impetus for policy development; a reasonable role of science is to determine how the intent of policy can best be realized. In recent years, the policy of educating all handicapped students has been reevaluated primarily because of two factors: (a) costs associated with providing educational services and (b) disagreement among professionals concerning whether all handicapped students can benefit from an education. A review of the educability litigation reaffirms that equal educational opportunity is still valued, and education can be defined broadly. Rather than questioning the value of equal educational opportunity, we suggest that research and curriculum development should focus on three areas: First, apply the criteria of educational validity (Voeltz & Evans, 1983) to demonstrate that education is appropriate; second, investigate student variance in learning associated with specific student characteristics and interventions; and third, evaluate valid curricular approaches for efficiency and cost-effectiveness.