Behavior Modification最新文献

Research featuring adults with intellectual and developmental disabilities who engage in problem behavior has outlined various treatment approaches. The current quantitative systematic literature review identified and coded 76 peer-reviewed and gray literature articles published between January 2002 and September 2022. Following article identification and coding, we calculated effect size estimates (i.e., Tau Baseline Corrected) and assessed the methodological rigor of included articles. Through this work, we uncovered 42 unique multi-protocol treatments (i.e., treatments incorporating multiple therapeutic elements). Multi-protocol treatments were associated with larger effect sizes (more effective) compared to single-protocol treatments. The average methodological rigor score associated with peer-reviewed works was 1.6 (out of 4), while gray literature works scored 1.2. We offer commentary in response to these outcomes, alongside recommendations for future research to address the many avenues of inquiry that appear to remain largely neglected (e.g., component analysis to evaluate individual treatment elements and their efficacy).

Research suggests that praise serves as a key component of behavioral interventions. However, residential facilities may lack systems to teach their staff members to provide praise to residents. As a structured approach to behavior management, an applied behavior analysis (ABA) team in a secure juvenile justice facility utilized group contingencies to increase written praise, termed "kudos," by staff members across five dormitories. While implementing the Kudos program, the ABA team measured the frequency of (a) verbal and gestural forms of praise to evaluate generalization from written Kudos and (b) residents' problem behavior. Results of statistical analyses indicated increased written praise by staff members was associated with decreased problem behavior by residents; however, the written behavior of staff did not generalize to verbal and gestural forms of praise toward residents. Practice implications, including strategies for implementing praise consistently in juvenile justice settings, are discussed.

Research has shown that instructive feedback (IF) facilitates the generalization of tacts in individuals with autism spectrum disorder (ASD). However, no study to date has examined the effects of IF on the emergence of tacts across primary and secondary languages with both trained and non-trained exemplars. This study evaluated the efficacy of IF in promoting the generalization of tacts across languages using a nonconcurrent multiple baseline design with four participants with ASD from Spanish-speaking families. The results demonstrated that IF was effective at producing generalization across novel stimuli exemplars in primary and secondary targets for two of the four participants. Additional training components (i.e., rehearsals and no-no prompts) were effective in producing the same generalization outcomes with the remaining two participants.

There is little known about the behavior intervention plan (BIP) team composition for students with intellectual disability, developmental delay, and/or autism (i.e., IDD). We sought to understand whether students with IDD are included as part of the team to develop their BIPs and who is involved and the correlation with quality of the BIP. We reviewed and statistically analyzed records from 87 BIPs from one large school district. Of the records reviews, most BIP teams included a parent or guardian, administrator, general education teacher, and special education teacher. Less than 5% of BIPs included a student with IDD. Implications for policy and practice are provided. Specifically, federal and state policy guides are needed to ensure that BIP teams include both the individual with IDD and their parents or guardians, along with individuals with expertise in supporting students with IDD.

Conducting a functional analysis (FA) is considered the gold standard for assessing the function of disruptive behavior and informing function-based treatment plans for individuals with autism and developmental disabilities. However, data collected during FAs are subject to human error. Accelerometers are wearable sensors that capture an individual's movement and can be used to identify behavioral events. The purpose of this study was to pilot the use of accelerometers to identify the occurrence of self-injurious behavior events during a FA. Three participants with autism, who engaged in self-hitting behaviors, participated in this study. Researchers conducted a FA with the participants while they wore small accelerometer devices. Observational data were collected using (1) live observation ("clinical-grade"), (2) from frame-by-frame video analysis ("research-grade"), and (3) via accelerometers. Researchers calculated interobserver agreement across data sets. Discussion of results and recommendations for practice and future research are included.

Interventions aimed at enhancing social cognition deficits in individuals with schizophrenia are globally supported by evidence demonstrating improvements in various functional outcomes. The Social Cognition and Interaction Training (SCIT) intervention was adapted for use in the Indian context for individuals with schizophrenia using the Reporting Cultural Adaptation in Psychological Trials (RECAPT) guidelines, informed by expert consultations. This included contextually relevant changes in the resource materials (print, photographs, and video) and the development of additional resources. Changes in the intervention delivery process included the use of individual sessions with adjunctive group sessions. Initial feasibility was assessed via a pilot tryout of the adapted SCIT on three persons diagnosed with schizophrenia. This informed additional changes for future applications of the adapted SCIT, such as structured involvement of family members as practice partners and modifications in the intervention delivery format. Content validation process for the final adapted intervention modules was carried out by four mental health practitioners. The experiences, challenges, and decision-making process involved in the adaptation are outlined, along with implications for future research and contextually tailored intervention strategies.

Impaired cognitive functioning is a common feature of serious mental illness that contributes to worse psychosocial functioning and attenuated response to psychiatric rehabilitation. To address these impairments, cognitive remediation (i.e., interventions aimed at enhancing cognitive abilities such as attention and memory based on learning principles with the goal of improving psychosocial adjustment) has emerged in recent decades as a dynamic, rapidly evolving evidence-based practice. In this introduction we provide a summary of controlled research on the effects of cognitive remediation on cognitive and psychosocial functioning in people with serious mental illness, highlighting the results of three meta-analyses using similar methods conducted over 14 years. We next review different methods employed in cognitive remediation and summarize the recommendations of a consensus expert panel on the critical component of effective programs. We then highlight four papers in this special issue that illustrate the broad range of applications and research questions addressed in contemporary research on cognitive remediation. One paper examines the intriguing effects of combining cognitive remediation with aerobic exercise to improve psychotic symptoms in first episode psychosis, while a second one explores the feasibility of using cognitive remediation to enhance independent living skills training in people living in locked supervised residential settings awaiting discharge into the community. A third paper describes the processes involved in the cultural adaptation of a widely researched program for improving social cognition. The fourth paper considers what has been learned about the effects of cognitive remediation and tackles questions related to increasing its implementation and dissemination.

We examined the effects of combining cognitive training plus aerobic exercise versus cognitive training alone on positive symptoms in recent-onset schizophrenia patients. Sixty-eight participants were randomly assigned to Cognitive Training plus Exercise (CT&E, N = 37) or Cognitive Training alone (CT, N = 31). All participants were also randomly assigned to either oral risperidone or paliperidone palmitate (PP1M) in a concurrent antipsychotic medication study. All participants were provided four weekly sessions of internet-based cognitive training conducted in a group format for 6 months, during which half were randomized to receive a 150 min/week aerobic exercise program. Then participants received 6 additional months of treatment at half of the psychosocial intervention frequency. Reality Distortion, the mean of BPRS ratings of Unusual Thought Content and Hallucinations, was averaged over all available BPRSs during the 3-month pre-baseline period and over four 3-month time periods during the 12 months of intervention. The proportion of BPRS administrations wherein either Unusual Thought Content or Hallucinations was rated >4 was used as a measure of breakthrough psychotic symptoms. Reality Distortion significantly decreased over time for the CT&E group compared to the non-Exercise (CT) group, F(4, 208) = 2.9, p = .02. The proportion of BPRS ratings with breakthrough symptoms decreased over successive 3-month periods for the CT&E group compared to the CT group, F(4, 218) = 6.9, p < .0001. The two medication groups did not significantly differ on either positive symptom outcome, and there were no three-way interactions. Our findings suggest that the enhancing effect of adding aerobic exercise to cognitive training extends beyond cognitive gains and includes positive psychotic symptoms.

Cognitive remediation (CR) is an evidenced-based intervention, but is not consistently included in clinical guidelines, nor implemented widely in mental health services, and is still not fully accepted as a psychological therapy. This is despite demonstrating a boost to recovery, and reductions in health care costs. We describe potential issues as CR matures into a widely accepted and used psychological therapy by drawing on high-quality evidence from reviews and meta-analyses and specifically highlight how CR uses therapeutic formulation, similar to other psychological therapies, to address specific client needs. Most evidence is for those with a diagnosis of schizophrenia, but we also consider CR benefits for other mental health conditions. Data emerging from different health systems are, at last, providing information on how CR is used, disseminated and practice standards maintained. This may be the information needed to support further implementation, expansion, and consolidation of CR use globally.

Many people with serious mental illness (SMI) experience cognitive disabilities and poor independent living skills which limit their ability to live independently in the community. This study examined the feasibility and initial effectiveness of integrating a new cognitive remediation program, Thinking Skills for Life (TSL), into independent living skills training programs in four secure residential treatment facilities (SRTFs) to facilitate discharge to more independent living situations. Participants were 30 individuals in the SRTF, of whom 11 were forensically committed to the SRTF. Results showed the intervention was feasible to implement, with 97% of participants exposed to TSL and 67% completing the program. Initial promise of the TSL program at improving independent living was suggested by post cognitive program discharge to less restrictive living situations of 63% of participants not on forensic commitment, and 55% of those on forensic commitment. These promising findings set the stage for more rigorous evaluation of the efficacy of the TSL program.