Group cognitive -behavioral therapy for heterogeneous anxiety disorders in children and adolescents: A multiple baseline study

This study investigated the efficacy of Group Cognitive-Behavioral Therapy (GCBT) in the treatment of heterogeneous anxiety disorders in children. A partially nonconcurrent multiple baseline across groups design was used to assess the effects of the treatment on 12 clinically referred children and adolescents between 6 and 16 years of age who met DSM-IV criteria for an anxiety disorder. Targeted diagnoses included Obsessive Compulsive Disorder, Simple Phobia, Separation Anxiety Disorder, Social Phobia, and Generalized Anxiety Disorder, with three of the children also presenting with school refusal behavior. Duration of baseline for each of the three groups varied and ran for one, two, or three weeks. Dependent measures included diagnostic status, child and parent-completed reports, and daily child and parent ratings of child anxiety severity. Results indicated that GCBT was efficacious in reducing anxious symptoms in children and adolescents treated in diagnostically heterogeneous groups, and that gains were generally maintained at 6 and 12 month follow-ups. Findings are discussed in terms of their theoretical and practical implications for the efficient treatment of children and adolescents with anxiety disorders. ^

Functional communication training for the treatment of multiply determined behaviour in two boys with autism

Functional communication training was used to replace multiply determined problem behaviour in two boys with autism. Experiment 1 involved a functional analysis of several topographies of problem behaviour using a variation of the procedures described by Iwata, Dorsey, Slifer, Bauman, and Richman. Results suggested that aggression, self-injury, and disruption were multiply determined (i.e., maintained by both attention and access to preferred objects). Experiment 2 involved a multiple-baseline design across subjects. The focus of intervention was to replace aggression, self-injury, and disruption with functionally equivalent communicative alternatives. Both boys were taught alternative “mands” to recruit attention and request preferred objects. Acquisition of these alternative communication skills was associated with concurrent decreases in aggression, self-injury, and disruption. Results suggest that multiply determined challenging behaviour can be decreased by teaching an alternative communication skill to replace each assessed function of the problem behaviour.

Psychological management of intractable seizures in an adolescent with a learning disability

Psychological interventions aimed at seizure management are described with a 14-year-old buy with a learning disability and intractable epilepsy. Baseline records suggested that a majority of tonic seizures and 'drop attacks' were associated with going off to sleep and by environmental 'startles'. Psychological formulation implicated sudden changes in arousal levels as an underlying mechanism of action. Cognitive-behavioural countermeasures were employed to alter arousal levels and processes in different ways in different 'at-risk' situations. A multiple baseline design was used to control for non-specific effects of interventions on non-targeted seizures. Results suggested significant declines in the number of sleep onset and startle-response seizures were attained by these methods. Gains were maintained at 2-month follow-up. (C) 1999 BEA Trading Ltd.

Using fuction-based CBT with parent involvement to treat OCD in two school-age children with high-functioning autism

Obsessive Compulsive Disorder (OCD) involves excessive worry coupled with engaging in rituals that are believed to help alleviate the worry. Pervasive Developmental Disorders (PODs) are characterized by impairments in social interaction, communication, and the presence of repetitive and/or restrictive behaviours (American Psychiatric Association, 2000). Research suggests that as many as 81% of children with a POD also meet criteria for a diagnosis ofOCD. Currently, only a handful of studies have investigated the use of Cognitive Behavioural Therapy (CBT) in treating OCD in children with autism (Reaven & Hepburn, 2003 ; Sze & Wood, 2007; Lehmkuhl, Storch, Bodtish & Geflken, 2008). In these case studies. the use of a multi-modal CBT treatment package was successful in alleviating OCD behaviours. The current study used function-based CBT with parent involvement and behavioural supplements to treat 2 children with POD and OCD. Using a multiple baseline design across behaviours and participants, parents reported that their child 's anxiety was alleviated and these gains were maintained at 6-month follow-up. According to results of the Children 's Yale-Brown Obsessive Compulsive Scale (Goodman, Price, Rasmussen, Riddle, & Rapoport, 1986) from preto post-test, OCD behaviours of the children decreased II"om the severe to the mild range. In addition, the parents rated the family's level of interference related to their child 's OCD as substantially lower. Last, the CBT treatment received high ratings of consumer satisfaction.

Dyad function-based cognitive behavioural therapy as a treatment for obsessive compulsive disorder in two school aged children with high functioning autism

Children with High-Functioning Autism (HF A) are more vulnerable to developing Obsessive Compulsive Disorder (OCD) than typically developing children and those with Low-Functioning Autism (Gadow et al., 2005). This study used a multiple baseline design across behaviours (Cooper, Heron, & Heward, 2007) to investigate if a two phase function-based Cognitive Behaviour Therapy (CBT) would decrease obsessive compulsive behaviours (OCBs) in two children ages 7 and 9 who met criteria for OCD and HF A. This multimodal treatment package consisted of treatment enhancements to meet the children's cognitive, linguistic, and social challenges associated with their HF A diagnosis, as well as a manual and accompanied children's workbook (Vause, Neil, & Feldman, in progress). In line with previous research conducted on CBT as a treatment for OCD in this population (e.g., Wood et at, 2009), the children in this study experienced clinically significant decreases in their OCBs as a result of receiving the CBT protocol.

I Believe in me, not OCB: Evaluation of Group Function-Based CBT as a Treatment for Obsessive Compulsive Behaviour in Four Children with HFA

Researchers have conceptualized repetitive behaviours in individuals with Autism Spectrum Disorder (ASD) on a continuum oflower-Ievel, motoric, repetitive behaviours and higher-order, repetitive behaviours that include symptoms ofOCD (Hollander, Wang, Braun, & Marsh, 2009). Although obsessional, ritualistic, and stereotyped behaviours are a core feature of ASD, individuals with ASD frequently experience obsessions and compulsions that meet DSM-IV-TR (American Psychiatric Association, 2000) criteria for Obsessive-Compulsive Disorder (OCD). Given the acknowledged difficulty in differentiating between OCD and Autism-related obsessive-compulsive phenomena, the present study uses the term Obsessive Compulsive Behaviour (OCB) to represent both phenomena. This study used a multiple baseline design across behaviours and ABC designs (Cooper, Heron, & Heward, 2007) to investigate if a 9-week Group Function-Based Cognitive Behavioural Therapy (CBT) decreased OCB in four children (ages 7 - 11 years) with High Functioning Autism (HFA). Key treatment components included traditional CBT components (awareness training, cognitive-behavioural skills training, exposure and response prevention) as well as function-based assessment and intervention. Time series data indicated significant decreases in OCBs. Standardized assessments showed decreases in symptom severity, and increases in quality of life for the participants and their families. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed child are discussed.

The effect of the GENTLE/s robot-mediated therapy system on arm function after stroke

Objective: To evaluate the effect of robot-mediated therapy on arm dysfunction post stroke. Design: A series of single-case studies using a randomized multiple baseline design with ABC or ACB order. Subjects (n = 20) had a baseline length of 8, 9 or 10 data points. They continued measurement during the B - robot-mediated therapy and C - sling suspension phases. Setting: Physiotherapy department, teaching hospital. Subjects: Twenty subjects with varying degrees of motor and sensory deficit completed the study. Subjects attended three times a week, with each phase lasting three weeks. Interventions: In the robot-mediated therapy phase they practised three functional exercises with haptic and visual feedback from the system. In the sling suspension phase they practised three single-plane exercises. Each treatment phase was three weeks long. Main measures: The range of active shoulder flexion, the Fugl-Meyer motor assessment and the Motor Assessment Scale were measured at each visit. Results: Each subject had a varied response to the measurement and intervention phases. The rate of recovery was greater during the robot-mediated therapy phase than in the baseline phase for the majority of subjects. The rate of recovery during the robot-mediated therapy phase was also greater than that during the sling suspension phase for most subjects. Conclusion: The positive treatment effect for both groups suggests that robot-mediated therapy can have a treatment effect greater than the same duration of non-functional exercises. Further studies investigating the optimal duration of treatment in the form of a randomized controlled trial are warranted.

Efeitos de um programa de intervenção metatextual em escolares com dificuldades de aprendizagem

Pós-graduação em Educação - FFC

Effects of a metatextual intervention program in developing written narratives of students with learning difficulties

This study aimed to verify the effects of a metatextual intervention program, in the elaboration of stories written by students with learning difficulties. Four students were included in the sample of both genders, with ages ranging between eight years and four months and ten years and two months of age. The program was implemented at the participant schools, using an approach of multiple baseline within-subjects, with two conditions: baseline and intervention. Data analysis was based on the classification of stories produced by the students. Mann-Whitney testing was also applied, to analyze whether there have been significant changes in these productions. The results indicated that all students have improved performance in relation to the categories of produced stories, from elementary schemas (33%), for a more elaborate scheme (77%), with a better structuring of the elements that constitute a story. Statistical analysis also showed that the intervention has produced significant results for all variables analyzed. The data obtained have shown that the program was effective.

O uso do treino de habilidades sociais em pessoas com fobia social na terapia comportamental

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O uso do treino de habilidades sociais em pessoas com fobia social na terapia comportamental

The effects of an intervention in social skills were assessed in four university students with ages between 19 and 31, with social phobia diagnosis. The performance in social skills as well as performance-compatible disorder was assessed before, after the intervention, and follow-up in four months later, by the instruments: SCID-I, Mini-SPIN, QACC-VU and IHS in a multiple baseline design among participants. The intervention programmed twelve weekly meetings in which the researcher discussed socially skilled alternatives to the described difficulties; leaded dialogued theoretical explanations about the theme of the meeting and also performed functional assessments and repertory training of the participants. It was observed deficits such as public speaking, starting and maintaining conversation in the participants’ social skills repertory, which are consistent with the criteria for social phobia and the difficulties into the adapting to university. After the intervention, the participants left difficulties in public speaking, performance characteristic compatible with the social phobia diagnosis and they also increased social repertory, although it is still necessary the improvement of other skills, such as expressing positive feeling.

Nurturing Young Students' Writing Knowledge, Self-Regulation, Attitudes, and Self-Efficacy: The Effects of Self-Regulated Strategy Development (SRSD)

The purpose of this study was to investigate the effectiveness of implementing the Self-Regulated Strategy Development (SRSD) model of instruction (Graham & Harris, 2005; Harris & Graham, 1996) on the writing skills and writing self-regulation, attitudes, self-efficacy, and knowledge of 6 first grade students. A multiple-baseline design across participants with multiple probes (Kazdin, 2010) was used to test the effectiveness of the SRSD instructional intervention. Each participant was taught an SRSD story writing strategy as well as self-regulation strategies. All students wrote stories in response to picture prompts during the baseline, instruction, independent performance, and maintenance phases. Stories were assessed for essential story components, length, and overall quality. All participants also completed a writing attitude scale, a writing self-efficacy scale, and participated in brief interviews during the baseline and independent performance phases. Results indicated that SRSD can be beneficial for average first grade writers. Participants wrote stories that contained more essential components, were longer, and of better quality after SRSD instruction. Participants also showed some improvement in writing self-efficacy from pre- to post-instruction. All of the students maintained positive writing attitudes throughout the study.

Effects of Training and E-Mail Feedback on Behavior Therapists' Use of Instructive Feedback

Thesis (Ph.D.)--University of Washington, 2016-06