Clinical effects of buspirone on intractable self-injury in adults with mental retardation

OBJECTIVE

The efficacy of buspirone in controlling self-injurious behavior was examined in five individuals with mental retardation. Buspirone was used alone in two individuals and as an adjunct to thioridazine in the other three.

METHOD

Standard behavioral observation methods were used to collect data on the number of self-injurious responses of the individuals during baseline and several doses of buspirone in an open trial.

RESULTS

When compared with baseline levels, all five individuals showed some response to buspirone, with reductions in self-injury ranging from 13% to 72%, depending on the dose. The most effective dose of buspirone was 30 mg/day for three individuals and 52.5 mg/day for the other two. These individuals were maintained for 6 to 33 weeks on their most effective dose. Coexistent symptoms of anxiety did not predict a favorable response to buspirone therapy.

CONCLUSIONS

Buspirone showed a mixed but generally favorable response in controlling intractable self-injury in this and four previous studies reporting similar cases. However, the drug should not be endorsed as a proved treatment for self-injury until similar results have been obtained from well-controlled studies of its efficacy.

Fluoxetine treatment of severe self-injury in young adults with mental retardation

Dysfunction of the serotonergic system has been implicated in the development and maintenance of self-injury in some persons with mental retardation. Several preliminary reports have suggested that fluoxetine, a drug that blocks the reuptake of serotonin, may decrease self-injury in these individuals. Of the 44 cases of self-injury treated with fluoxetine and previously reported in the literature, 42 demonstrated a beneficial response to the drug. We report four additional cases of adults with mental retardation whose self-injury was treated with fluoxetine. Each of these individuals benefited from fluoxetine to some extent, with average decreases in self-injury ranging from 20% to 88% when compared with baseline levels. These findings, combined with those from previously published case studies, emphasize the need for well-controlled studies to more adequately assess the effects of fluoxetine on self-injury.

Effects of thioridazine and visual screening on stereotypy and social behavior in individuals with mental retardation

Thioridazine and visual screening procedures are effective in reducing the stereotypic behaviors of individuals with mental retardation. A double-blind, placebo-controlled study, using alternating treatments within a multiple-baseline across subjects design, was conducted to assess the effects of two doses of thioridazine (1.25 and 2.5 mg/kg/day) and visual screening, alone and combined, on stereotypy and social behavior of three individuals with profound mental retardation. Functional analyses did not show demand, alone, social attention, or differential reinforcement conditions to maintain the subjects' stereotypy. Thioridazine was effective in producing modest reductions in stereotypy and minor increases in social behavior across subjects. The higher dose of thioridazine (2.5 mg/kg/day) was slightly more effective than the lower dose (1.25 mg/kg/day), and thioridazine plus visual screening was more effective than thioridazine alone. The most effective treatment was visual screening when used in the absence of thioridazine. This study demonstrates a method for assessing the impact of psychopharmacological and behavioral interventions in individuals for whom a behavioral treatment cannot be easily derived from a functional analysis of the maintaining conditions of the target behavior.

Role of macrophages in experimental malaria: I. Development of immunobioassay indicators

The role of macrophages in immunogenic mechanisms of malaria was studied. The first part of the study aimed at development of indicators for assessing immunobioassay. Accordingly, data on the natural course of lethal Plasmodium berghei infection in mice were collected, and baseline estimates of a set of indicators were made. The indicators along with their estimated means are: prepatent period (PP), 2.57 +/- 0.06 days; survival period (SP), 17.63 +/- 0.29 days; median survival day (MSD), 17.20 days; and parasite density 24 h before death (K), 3582.6 infected RBC/10(4)RBCs. The probable role of immunogenic mechanisms judged indirectly by course of parasitaemia in different phases is discussed.

Factor structure of the Motivation Assessment Scale

The Motivation Assessment Scale (MAS) was developed to provide clinical information on four hypothesized functions that may control problem behaviour in persons with developmental disabilities. The original four-factor structure of the MAS was based on face validity, with the items being grouped in terms of each of the hypothesized functions. Validation of the scale was provided in terms of correlations between teacher ratings of eight children on the MAS and ranking of the controlling variables from functional analogue tests. In this study, staff in residential facilities rated 60 residents and teachers in schools rated 96 students on the MAS. The target behaviour rated for both samples was self-injury, with the institutional sample engaging in the behaviour more than 15 times an hour and the school sample, less than 15 times an hour. The results of factor analyses, with varimax rotation, provided a conceptually meaningful factor structure with the institutional sample, but not with the school sample. The 16 MAS items resolved into four factors that were conceptually related to four conditions that may maintain problem behaviour (i.e. sensory, escape, attention and tangible). The results suggested that the original MAS has a robust factor structure and may be clinically useful in predicting the controlling functions of problem behaviours, if the target behaviours occur at a rate no less than 15 responses per hour.

Recognition of facial expressions of emotion by persons with mental retardation. A matched comparison study

Children and adults with mental retardation were tested on their ability to recognize facial expressions of emotion. The sample consisted of 80 children and adults with mental retardation and a control group of 80 nonhandicapped children matched on mental age and gender. Ekman and Friesen's normed photographs of the six basic emotions (anger, disgust, fear, happiness, sadness, and surprise) were used in a recognition task of facial expressions. Subjects were individually read two-sentence stories identifying a specific emotion, presented with a randomized array of the six photographs of the basic facial expressions of emotion, and then asked to select the photograph that depicted the emotion identified in the story. This procedure was repeated with 24 different stories, with each of the six basic emotions being represented four times. Results showed that, as a group, individuals with mental retardation were not as proficient as their mental-age-matched nonhandicapped control subjects at recognizing facial expressions of emotion. Although adults with mild mental retardation were more proficient at this task than those with moderate mental retardation, this finding was not true for children. There was a modest difference between the children with moderate mental retardation and their nonhandicapped matched controls in their ability to recognize facial expression of disgust.

Enhancing the ability of adults with mental retardation to recognize facial expressions of emotion

The ability to recognize accurately and respond appropriately to facial expressions of emotion is essential for interpersonal interaction. Individuals with mental retardation typically are deficient in these skills. The ability of 7 adults, 1 with severe and 6 with moderate mental retardation, to recognize facial expressions of emotion correctly was assessed. Then, they were taught this skill using a combination of a discrimination training procedure for differentiating facial movements, directed rehearsal, and Ekman and Friesen's "flashing photograph" technique. Their average increase in accuracy over baseline was at least 30% during the course of the training and over 50% during the last 5 days of the training phase. Further, these individuals were able to generalize their skills from posed photographs to videotaped role plays and were able to maintain their enhanced skills during the 8 to 9 months following the termination of training. This is the first study to show that individuals with mental retardation can be taught skills that enhance their ability to recognize facial expressions of emotion.

A model for the treatment of encopresis

Encopresis is a relatively common childhood disorder that continues to be poorly understood. An integrated assessment and treatment model for this disorder is presented. Data generated from a comprehensive assessment enables the diagnosis and identification of subtypes of encopresis based on objective, identifiable criteria. The rationale and methods for treating each subtype of encopresis then is presented. In addition, the importance of assessing and treating psychiatric comorbidity in children with encopresis is highlighted.

Recognition of facial expressions of emotion by persons with mental retardation

A sample of 511 children and adults with mental retardation or borderline intelligence (1 SD below the mean IQ) and children of average intelligence were tested on their ability to recognize the six basic facial expressions of emotion as they are exemplified in Ekman and Friesen's (1975) normed photographs. Each subject was shown four sets of six photographs, one of each emotion. Subjects were read 24 short stories; after each one they were asked to point to the photograph that depicted the emotion described. Children and adults with mental retardation or borderline intelligence were less proficient at identifying facial expressions of emotion than were children of average intelligence. Among individuals with mental retardation or borderline intelligence, recognition of accuracy of facial emotion increased with IQ. Among individuals with average intelligence, recognition accuracy increased with age.

Assessment and diagnosis of mental illness in persons with mental retardation. Methods and measures

The assessment and diagnosis of psychiatric disorders in individuals with mental retardation has been a neglected area of research. However, current research indicates that these individuals suffer from the same range of psychiatric disorders that is evident in those who are not mentally retarded. A model of assessment and diagnosis of mental illness in this population is presented that incorporates psychiatric as well as behavioral methods. The emphasis is on the comprehensive assessment of an individual's behavior, based on family history, self and informant clinical interviews, rating scales, direct observations, and an experimental analysis of the target behaviors. The model provides the basis for making differential diagnoses in terms of related psychiatric disorders and between psychiatric disorders and behavior problems. Depression and schizophrenia are used as illustrative disorders to describe the application of this model. Given the paucity of literature on the assessment and diagnosis of mental illness in individuals with mental retardation, a number of suggestions are made regarding future research and refinement of the model.

Enhancing the spelling performance of learning disabled students. Task variation does not increase the efficacy of directed rehearsal

We investigated whether the efficacy of directed rehearsal could be enhanced by increasing a student's motivation through task variation. The efficacy of three conditions (directed rehearsal, directed rehearsal combined with task variation, and no-training control) on the spelling performance of four students with learning disabilities was compared in an alternating treatments design. Following each spelling error during the directed rehearsal condition, the teacher pronounced the word, the student pronounced the word, the teacher said aloud each letter of the word, and the student said aloud each letter of the word as he wrote the word correctly. This sequence was repeated five times. The same procedure was used during directed rehearsal plus task variation, except that previously learned words were alternately presented with new words. Results showed that although the two training conditions were more effective than no training, there was no difference between the two training procedures in terms of the cumulative number of words learned to criterion. This study showed that the addition of task variation to directed rehearsal does not increase the spelling proficiency of learning disabled students.

Overcorrection as an academic remediation procedure. A review and reappraisal

Overcorrection procedures traditionally were designed to reduce the behavioral excesses of persons with mental retardation. However, beginning with a study of Foxx and Jones (1978), it became clear that variations of the procedure could be used to enhance academic proficiency in students with average intelligence, borderline intelligence, learning disabilities, and various levels of mental retardation. Studies were reviewed in this article that have used overcorrection procedures to enhance academic proficiency, and it was concluded (a) that overcorrection, alone or combined with positive reinforcement, significantly increased the academic proficiency of the students, and (b) that the label "overcorrection" is inappropriate, given that the procedures described in these studies did not meet the criteria for overcorrection procedures. It was suggested that overcorrection procedures used for academic remediation be called directed rehearsal in the future to reflect more accurately the procedures actually used.

Social behavior of students who are seriously emotionally disturbed. A quantitative analysis of intervention studies

The social behavior of students who are seriously emotionally disturbed sets them apart from their normative classroom peers. This article provides a quantitative analysis of intervention studies dealing with the social behavior of seriously emotionally disturbed students. Social behavior was broadly defined as including social skills deficits, behavior under inadequate stimulus control, and inappropriate behavior in the classroom. Of the 28 studies located, 11 dealt with some aspect of social skills and 17 with inappropriate classroom behavior. Each study was analyzed with respect to (a) the age, gender, and classification of the subjects; (b) the setting, referral source, and therapist; (c) the dependent and independent variables; (d) type of evaluation design used; (e) reliability of the dependent and independent variable; (f) social validation; (g) programmed generalization, maintenance, and follow-up; (h) measurement of collateral behaviors; (i) functional analysis of the target behavior; and (j) efficacy rating of the results on a 3-point scale. The results are presented and discussed in terms of current status and implications for future research.

Effects of two error-correction procedures on oral reading errors. Word supply versus sentence repeat

The effects of two error-correction procedures on oral reading errors and a control condition were compared in an alternating treatments design with three students who were moderately mentally retarded. The two procedures evaluated were word supply and sentence repeat. The teacher supplied the reader with the correct word immediately after each student error during the word-supply condition. During the sentence-repeat condition, the teacher supplied the correct word immediately after each student error, required the student to repeat the correct word, complete reading the sentence, and then reread the entire sentence. Both word-supply and sentence-repeat procedures were effective in reducing oral reading errors when compared to a no-intervention control condition, but sentence repeat was superior to word supply. In addition, a similar relationship was found between the two procedures when the students were tested for retention on the same reading passages a week later. These results show that sentence repeat is more effective than is the commonly used word-supply procedure in remediating the oral reading errors of students with moderate mental retardation.

A stimulus control analysis of the picture-word problem in children who are mentally retarded: the blocking effect

Conditioning to one member of a compound stimulus can be blocked by the presence of a second member to which the response was previously conditioned. This account of selective stimulus control can be used to explain the finding that pictures inhibit learning of written words if the relevant pictures and their verbal equivalents have been paired previously. We tested the blocking explanation of the picture-word problem with 8 mentally retarded students. Following baseline, each student was resented daily with four conditions in an alternating treatments design. In Condition A (blocking), a picture was presented alone and then was followed by the presentation of a picture and written word compound stimulus; in Condition B (blocking/control), a word was presented alone; in Condition C(blocking minimized), a word was enhanced in size and presented alone followed by the word and a picture; and, in Condition D (blocking minimized/control), the enhanced word was presented alone. Each stimulus was presented for 15 s. All students had the lowest percentage of words read correctly in the blocking condition, and all improved when blocking was minimized. Six of 8 students reached their highest percentage of words read correctly in the two control conditions when the words were presented as a single stimulus without pictures. These results indicate that pictures inhibit some students' learning of new words; this may be due to the blocking of conditioning to written words by prior conditioning to pictures.

The representativeness of observational samples of different durations

The representativeness of behavioral observation samples with durations of less than the whole time of interest was investigated. A real-time recording system was developed to quantify the behavior of 5 profoundly mentally retarded physically handicapped adult students in an institutional training setting. Behavior was observed using six mutually exclusive and exhaustive categories during 2.5-hr observation sessions. Sample observation sessions with durations ranging from 15 to 135 min were computer simulated from the whole-session (150-min) records. It was found that the representativeness of these samples, when compared to whole-session records, was a function of the relative duration of the behavioral categories and of sample duration. The occurrence of relatively high-duration behaviors (lasting for more than 50% of the session) was estimated to within 20% error by samples of less than 60 min, but low-duration behaviors (1 to 3% of the session) were inadequately quantified even from 135-min samples. Increasing irregularity of bouts of behavior in the low-duration behaviors is suggested as the cause of the functions obtained. Implications of the findings for applied behavior analysis are discussed, with the recommendation that the adequacy of observational session durations be empirically assessed routinely.

An evaluation of gentle teaching and visual screening in the reduction of stereotypy

Gentle teaching and visual screening techniques have been used to control severe behavior problems in persons with mental retardation. An alternating treatments design was used to compare gentle teaching, visual screening, and a task-training condition in the reduction of the high-level stereotypy of 3 persons with mental retardation. Following a baseline phase, a task-training condition using standard behavioral techniques was implemented to establish the effects of training the subjects on the tasks. Results showed a modest decrease in stereotypy. This phase was followed by an alternating treatments phase in which visual screening, gentle teaching, and baseline conditions were compared. Both procedures were superior to the control condition in reducing stereotypic behavior, with visual screening being more effective than gentle teaching. When compared with data from the prior phase, gentle teaching was found to be more effective than task training for 2 subjects but less effective for the 3rd, whose stereotypy increased during gentle teaching. Two succeeding phases in which visual screening was implemented across two and then all three daily conditions reduced stereotypy further to near-zero levels. An additional phase with 1 subject demonstrated that the treatment effects of visual screening were easily replicated across therapists. Mixed and idiosyncratic changes in collateral behaviors occurred. For example, "bonding," the goal of gentle teaching, occurred at the same low levels under both treatments, contrary to the predictions of gentle teaching's proponents. The results indicate that gentle teaching may not be the universal treatment of choice for stereotypy its proponents suggest, and that it requires further empirical evaluation.

Increasing oral reading proficiency through overcorrection and phonic analysis

The comparative efficacy of overcorrection, phonic analysis, and no-intervention control condition in an alternating treatments design on the number of oral reading errors made by 3 children with moderate mental retardation was evaluated. During overcorrection each oral reading error resulted in the teacher providing the correct word and the child pointing to and saying the word correctly five times before rereading the sentence in which the error word occurred. During phonic analysis, the teacher directed the child to attend to various phonetic elements of the error word and to "sound out" the word. Results showed that the children made fewer errors under both training conditions when compared to the no-intervention control. Initially, the overcorrection procedure was more effective than phonic analysis in reducing the children's oral reading errors, but this changed with further training, and phonic analysis proved to be more effective with all children. These data suggest that both overcorrection and phonic analysis are effective in increasing oral reading proficiency but phonic analysis is more effective with extended training.

Pharmacokinetics of ibuprofen enantiomers in humans following oral administration of tablets with different absorption rates

Ibuprofen (IB) is a racemic drug and is administered as such. While activity is due mainly to the S enantiomer, pharmacokinetic interpretations, as well as criteria to assess the bioequivalence of IB formulations, are based on measurements of the total (S + R) drug concentrations. IB enantiomers possess different disposition properties mainly as a result of R-to-S isomeric bioinversion. Inversion is maximal during the absorption phase, suggesting, perhaps, involvement of a presystemic process. This concept was evaluated in healthy subjects by crossover administration of four IB tablets having different absorption rates. The plasma concentrations of the individual isomers were measured using a stereospecific gas chromatographic assay. Differences among the products were insignificant with respect to the extent to the absorption. The S:R concentration ratios rose for 4 to 6 hr and then remained relatively unchanged. This observation was consistent with equal terminal t1/2 values for the enantiomers. There were significant differences between the peak times (Tmax) of the products. The S:R ratios of the concentrations at Tmax of S and AUC also differed; significant positive correlations were found between Tmax and the S:R ratios of Cmax. Thus the extent of R-to-S inversion, and hence the potency of a racemic dose of IB, may be absorption rate dependent.

Smoking cessation through cigarette-fading, self-recording, and contracting: treatment, maintenance and long-term followup

Seven adult subjects, all with extensive smoking histories, participated in a smoking cessation program. Intervention procedures included cigarette-fading, self-recording, and contracting. A changing-criterion analysis showed that six of the seven subjects were able to abstain from smoking within two months of intervention. The seventh subject was able to meet two changes in criterion, but dropped out of the treatment programme during the third. Of the sex remaining subjects, five were able to abstain from smoking during the six-month maintenance period. The sixth subject resumed smoking in the fourth month of maintenance and preferred to continue smoking thereafter. Followup data, collected every three months for two years, showed that the five remaining subjects were able to abstain from smoking for two years following the cessation of the maintenance programme.

The relationship between nurse characteristics and perceptions of psychotropic medications in residential facilities for the retarded

A total of 227 nurses were surveyed regarding their attitudes, perceptions, and knowledge about the use of psychotropic drugs. In general, greater age, male sex, status, and higher qualifications tended to covary and were associated with perception of greater involvement by senior nurses in drug-related decisions, more satisfaction with the level of in-service training, awareness of certain side effects, perception of interdisciplinary decision making as a clinical reality, and the view that psychologists were not influential in medication-related decisions. Those without these characteristics (e.g., females, younger nurses) more often advocated greater use of medical and laboratory tests, ongoing training, and alternatives to drugs. Nurses working in nonambulatory units more often saw senior nursing staff as influential in decisions to stop drug treatment and more often recommended that alternatives to pharmacology be employed. Some tentative conclusions about the dynamics surrounding medication use in these facilities were offered to account for these patterns.

Reliability of the Aberrant Behavior Checklist and the effect of variations in instructions

Interrater and test-retest reliabilities of the Aberrant Behavior Checklist were compared on the basis of type of instructions to raters. Three nurses in each of three residential units twice rated 28 mentally retarded residents, using one type of rating system, and the ratings were repeated 4 weeks later. The frequency-based instructions resulted in both higher interrater and test-retest reliability coefficients than did the other instructional types. Frequency-based ratings were performed again in another residential unit, but the higher reliabilities were not replicated. Interrater and test-retest reliability correlations varied markedly both across subscales and raters but were comparable to levels derived with other symptom checklists. We concluded that rater characteristics (e.g., motivation) are more powerful variables than are scoring systems.

Overcorrection of oral reading errors. A comparison of individual- and group-training formats

Overcorrection procedures have been found to be effective in increasing the reading proficiency of mentally retarded children. Evidence for the efficacy of overcorrection as a remediation procedure has been derived from studies using an individualized 1: 1, teacher-student, training format. In this study, an alternating-treatments design was used to measure the differential impact of an overcorrection procedure on the oral reading of four moderately mentally retarded children under individual-and group-training formats and a no-remediation control condition. During overcorrection, the teacher supplied the correct word when the child made an error and the child was then required to say the correct word five times before rereading the sentence in which it had occurred. Children made fewer oral reading errors under the two training formats when compared with the no-remediation control condition, but all children performed equally well under individual-and group-training formats. However, the generalization probe data suggest that the group-training format may increase the children's word recognition skills through incidental learning.

Microbiological systems in organic synthesis: preparation of racemic prenalterol utilizing Cunninghamella echinulata

The fungal microorganism Cunninghamella echinulata was utilized to para-hydroxylate the synthetic substrate (+/-)-1-isopropylamino-3-phenoxy-propan-2-ol (1). The resulting product, (+/-)-1-(4-hydroxyphenoxy)-3-isopropylamino-propan-2-ol, or (+/-)-prenalterol, (2) was formed in greater than 85% yield. Extracts from incubates were derivatized with trifluoroacetic anhydride and the concentrations of 1 and 2 were determined by GC on a fused silica methyl silicone capillary column with nitrogen-phosphorus detection. At substrate concentrations of 100 and 200 mg/L, the biotransformation proceeds with apparent first-order kinetics. With higher concentrations, the kinetics of prenalterol formation and substrate uptake appear to be nonlinear with a Km value of 427.8 micrograms/mL and a Vmax value of 232.3 micrograms/mL/d. This suggests that the biotransformation may proceed through a single-capacity limited pathway. The microbial product was isolated and identified as (+/-)-prenalterol by comparison (mp, IR, MS, 1H NMR) with an authentic specimen.

Independent and social play among profoundly mentally retarded adults: training, maintenance, generalization, and long-term follow-up

Play skills were taught to eight profoundly mentally retarded adults in two interrelated experiments. In Experiment 1, a multiple baseline across subjects design was used to assess the efficacy of verbal and physical prompts on independent play. In Experiment 2, the same subjects and experimental procedures were used to develop social play. Verbal prompting and graduated physical guidance procedures were found to be effective in substantially increasing independent play in Experiment 1 and social play in Experiment 2. Positive changes were also observed in collateral behaviors. Inappropriate play decreased slightly and stereotypy decreased to very low levels. Social interaction increased substantially in Experiment 2 when social play was targeted but little change was observed in Experiment 1 when only independent play was targeted. Treatment gains were maintained for 26 weeks in Experiment 1 and 10 weeks in Experiment 2. In addition, the treatment gains were generalized across subjects and settings in Experiment 2. Finally, regular follow-up checks showed that independent and social play remained in the repertoire of the subjects for 12 months following the termination of programmed maintenance.

Parents' acceptability ratings of alternative treatments for use with mentally retarded children

Parents of mentally retarded children rated the acceptability of four treatment techniques: differential reinforcement of incompatible behavior (DRI), over correction, time-out, and drug therapy. The treatments were described in a clinical case study of a mentally retarded child; acceptability was evaluated using the Treatment Evaluation Inventory and the Semantic Differential. The most acceptable treatment was DRI followed by overcorrection. Time-out and drug therapy proved least acceptable but were not rated significantly different from each other. This study extends findings from previous research on treatment accept- ability to parents of mentally retarded children, which is important because they are often involved in choices and implementation of treatment alternatives for their children.

Increasing recreational behavior in mentally retarded children

Mentally retarded children are frequently observed either to be inactive or to engage in stereotypic behaviors and isolate play. In this study, sign posting, pictorial prompts, and feedback were used to increase the recreational behaviors of 45 moderately and severely mentally retarded children. Treatment was introduced sequentially in a multiple-baseline fashion for ballplay and jungle gym activities across two school recess periods. Results showed large increases in the percentage of children participating in these activities that corresponded with the introduction of treatment. Similarly, the average amount of time the children played was roughly tripled. These gains were maintained over a 12-week follow-up period during which the pictorial prompts and feedback were gradually faded. The results demonstrate the efficacy of a simple, inexpensive, and practical way of generating higher levels of recreational play in large numbers of mentally retarded children.

Overcorrection of spelling deficits in moderately mentally retarded children

The present study focused on the acquisition and retention of spelling by moderately mentally retarded children who had not been taught any spelling skills as a part of their academic curriculum. Overcorrection plus positive reinforcement was used as the teaching technique with four children in a multiple baseline design. During training the teacher pronounced the target word and the child wrote the word, saying aloud each letter as it was written. If the word was spelled incorrectly, the following procedure was undertaken: The teacher pronounced the word again, the subject pronounced the word, the teacher said aloud each letter of the word, and the subject said aloud each letter of the word as he or she wrote the word correctly. This sequence was repeated five times following a misspelled word. The results showed that all four children rapidly learned to spell the target words and maintained correct spelling of the words during the six-month follow-up period.

Gas chromatographic separation of optically active anti-inflammatory 2-arylpropionic acids using (+)- or (-)-amphetamine as derivatizing reagent

A method is described for the derivatization of several non-steroidal anti-inflammatory arylalkanoic acids (ibuprofen, ketoprofen, naproxen, fenoprofen, flurbiprofen, pirprofen, cicloprofen, tiaprofenic acid, etodolic acid) with optically active amphetamine. The usefulness of this reagent compared to alpha-methylbenzylamine is described. The enantiomers are separated as diastereoisomers using capillary gas chromatography with nitrogen-phosphorus detection. The procedure is readily applied to the quantification of the enantiomers in urine and plasma samples.

Pharmacokinetics of the enantiomers of tiaprofenic acid in humans

A gas chromatographic method was utilized to study stereoselective pharmacokinetics of the nonsteroidal anti-inflammatory drug, tiaprofenic acid (5-benzoyl-alpha-methyl-2-thiopheneacetic acid), in four arthritic patients receiving 200 mg/8 h of the racemic drug. Synovial concentrations of the enantiomers were also measured following administration of single 200-mg doses of the drug to six other patients. In the analytical procedure, racemic tiaprofenic acid was coupled to (S)-(+)-amphetamine and the corresponding diastereoisomeric amide derivatives were resolved. Analysis of serial blood and urine samples at steady state, and single synovial samples, revealed that tiaprofenic acid enantiomers had superimposable plasma concentration-time and urinary excretion-time profiles and equivalent synovial concentrations. These results indicate that, unlike most 2-arylpropionic acid anti-inflammatory drugs, tiaprofenic acid enantiomers do not have different disposition kinetics, and the metabolic chiral inversion of one to the other does not occur or is so slow that the drug is eliminated before significant inversion takes place.

Reflections on the ex-smoker: some findings on successful quitters

Following the lead of Schachter [(1982). Am. Psychol. 37: 436-444] a questionnaire was developed to assess the process of self-cure among former cigarette smokers and then administered to 63 ex-smokers who had quit on their own. Separate samples of "helped" quitters and current smokers who had tried to quit but failed were also interviewed. Ex-smokers scored higher on Rosenbaum's [(1980). Behav. Ther. 11: 109-121] Self-Control Schedule, which suggests that they may have succeeded because they had better self-control skills initially. Other results underscored the role of peer pressure and curiosity as major reasons for becoming a smoker, of withdrawal symptoms and loss of pleasure as major obstacles to quitting, and of self-confidence and perceived health benefits as factors that were most important in successful quitting. The difficulty associated with quitting was associated with cognitive factors such as beliefs about the addictive properties of nicotine and self-confidence ratings, as well as with a supportive social network and the amount smoked previously.

Suppressive effects of visual and facial screening on self-injurious finger-sucking

Effects of following the self-injurious finger-sucking of two profoundly mentally retarded persons by 5 seconds of either visual or facial screening were compared using an alternating treatments design. The two screening procedures reduced the self-injury more than did a no-treatment control condition. Visual screening was more effective than facial screening with one of the subjects. Subsequently, when the only treatment was visual screening, the contrast in the effect on self-injury between visual screening and no-treatment was further increased. The greatest suppression occurred when visual screening was given in all sessions. Toy play reliably occurred only with appropriate training: The mere provision of toys had no impact on toy play. The effect of toy play on self-injury was equivocal. Possible limitations to the generality of the findings were discussed.

Treating self-injury: water mist spray versus facial screening or forced arm exercise

In three experiments, the effect of water mist spray on self-injurious and collateral behaviors was compared with either facial screening or forced arm exercise. Water mist spray was as effective as facial screening in suppressing face-slapping in Experiment 1. However, it was not as effective as facial screening for self-injurious finger-licking in Experiment 2 or forced arm exercise for excessive ear-rubbing in Experiment 3. These results suggest that while water mist spray is effective, it may be less so than alternative procedures. In Experiments 2 and 3 there was a consistent decrease in the occurrence of untreated maladaptive behaviors. In addition, there was a moderate increase in appropriate social interaction in Experiment 2 and a substantial increase in Experiment 3.

Increasing oral reading proficiency. A comparative analysis of drill and positive practice overcorrection procedures

A number of techniques have been used to correct oral reading errors and enhance word recognition accuracy. For example, drill has been shown to be effective with learning-disabled children, and positive practice procedures have been found to be effective with mentally retarded children. In the present study an alternating-treatments design was used to measure the differential effects of these two error correction procedures and a no-training control condition on the number of oral reading errors made by four moderately mentally retarded children. The extent to which the children retained their learning of the error words following intervention with drill and positive practice was also assessed one day after the initial reading of the passages. Results showed that when compared with the no-training control condition both error correction procedures were effective in reducing the number of oral reading errors, but that positive practice was superior to drill for all subjects. The retention data showed that fewer errors were made on those passages that had been remediated through positive practice. However, a comparison of the mean number of errors made during intervention and retention indicated that retention was marginally better under the drill condition than under positive practice.

Pharmacological treatment of self-injurious behavior in mentally retarded persons

Self-injury is a severe behavioral problem commonly observed in institutionalized mentally retarded individuals. While several forms of therapy are available, pharmacological treatment is most often used in institutions to control this behavior. This paper evaluated the clinical and experimental literature on the effects of pharmacotherapy for self-injury. Few general conclusions could be drawn mainly due to the small number of studies and the general lack of methodological rigor of these studies. However, there was some indication that antipsychotics and antimanics may prove to be useful in the treatment of self-injury and warrant further investigation. Several areas of future research were discussed.

On the modification of acceptability ratings for alternative child treatments

This study compared the acceptability of three child behavior therapy techniques (DRI, positive practice, and timeout). A fourth treatment (humanistic parenting) also was included for control purposes. Ratings were obtained from 96 introductory college students before and after they received systematic instruction in the use of the behavioral procedures. Preliminary results showed a clear preference for DRI, followed by humanistic parenting, and positive practice. Timeout received the least favorable evaluation. During the postinstruction phase, each of the three behavioral approaches was judged more favorably than before and, furthermore, there no longer were any consistent differences between them. Ratings on humanistic parenting declined as the behavioral treatments were judged more acceptable. The results extend Kazdin's earlier findings and indicate that acceptability ratings for alternative treatments are by .o means immutable. Behavioral treatments can be made more acceptable by appropriate educational means.

Controlling pica by components of an overcorrection procedure

Previous studies have shown that pica, the ingestion of inedible objects, can be effectively controlled in mentally retarded subjects using a two- or three-component overcorrection procedure or with one of these components in conjunction with another response-reduction procedure, differential reinforcement of other behavior. The present study showed that one of the components, oral hygiene, could eliminate pica by 2 retarded subjects when used alone. Although oral hygiene was the most effective component, each of the other components, tidying and personal hygiene, did decrease pica. In a later phase we found that a number of different therapists could easily and effectively implement the oral hygiene procedure.

Psychometric characteristics of the aberrant behavior checklist

Information was presented on the psychometric characteristics of the Aberrant Behavior Checklist. The internal consistency and test-retest reliability of the Checklist appeared to be very good. Interrater reliability tended to vary across raters and subscales and ranged from mediocre to good but was generally in the moderate range and acceptable for research purposes. Validity was assessed by comparing Checklist scores for residents presenting with attributes thought to reflect varying degrees of social adaptation. Validity was also evaluated by comparing Aberrant Behavior Checklist scores with ratings on adaptive behavior scales and with objective observations of behavior. In general, validity was established for most Aberrant Behavior Checklist subscales. Preliminary data from drug investigations suggested that the Checklist may provide a useful adjunct for the assessment of psychotropic drug effects.

The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects

The development of a scale to assess drug and other treatment effects on severely mentally retarded individuals was described. In the first stage of the project, an initial scale encompassing a large number of behavior problems was used to rate 418 residents. The scale was then reduced to an intermediate version, and in the second stage, 509 moderately to profoundly retarded individuals were rated. Separate factor analyses of the data from the two samples resulted in a five-factor scale comprising 58 items. The factors of the Aberrant Behavior Checklist have been labeled as follows: (I) Irritability, Agitation, Crying; (II) Lethargy, Social Withdrawal; (III) Stereotypic Behavior; (IV) Hyperactivity, Noncompliance; and (V) Inappropriate Speech. Average subscale scores were presented for the instrument, and the results were compared with empirically derived rating scales of childhood psychopathology and with factor analytic work in the field of mental retardation.

Reduction of rapid eating by normal adults

Three normal adults, who considered their eating habits socially unacceptable, were trained in the family home to eat at normal pace by gradually increasing their meal duration. Additional food, descriptive praise, and self-approval were made contingent upon a step-wise increasing criterion of meal duration. During maintenance, the additional food component was withdrawn. A multiple baseline experimental analysis showed that the treatment package was successful in decreasing rapid eating to normal rates, as measured by the subjects' self-monitoring of their meal durations. In addition, the increased durations were maintained when the food component was withdrawn from the treatment package in a subsequent phase.

Effects of delayed versus immediate attention to oral reading errors on the reading proficiency of mentally retarded children

The impact of two variations of teacher attention to oral reading errors and a no-treatment control condition were compared in an alternating treatments design. For four moderately mentally retarded children, each uncorrected oral reading error was followed by: (a) immediate teacher attention, with the teacher correcting the error word as soon as it occurred, (b) delayed teacher attention, with the teacher correcting the error word at the end of the sentence in which it occurred or within 10 to 15 seconds if the subject paused following an error, or (c) no teacher attention. Both immediate and delayed teacher attention were effective in reducing the number of uncorrected oral reading errors and increasing the number of self-corrections when compared to the no-treatment control. However, the delayed condition had greater effect than the immediate condition on both measures. In a later remediation phase, when only the delayed treatment was given, uncorrected errors remained at low levels whereas self-corrections generally increased. Total errors, whether subsequently self-corrected or not, with one exception, decreased during the study.

Suppression of pica by overcorrection and physical restraint: a comparative analysis

Overcorrection and physical restraint procedures have been shown to be effective in controlling certain classes of maladaptive behavior in mentally retarded persons. In the present study, an alternating treatments design was used to measure the differential effects of overcorrection and physical restraint procedures in the treatment of pica. Changes in collateral behaviors were also monitored. Each occurrence of pica was followed by either an overcorrection procedure or a physical restraint procedure. Although both procedures reduced the occurrence of pica and had a similar effect on the occurrence of collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.

Increasing physicians' awareness and use of community resources for mentally retarded persons

General practitioners must frequently deal not only with the physical health of their mentally retarded patients, but also with their psychological and emotional problems and with difficulties that their families have with coping. In the present study all general practitioners in one city were questioned about their knowledge of mental retardation, their ability to counsel families with a mentally retarded member and their knowledge and utilization of community agencies which provided services for the mentally retarded and their families. The majority of the 400 physicians who satisfactorily completed the questionnaire accepted an obligation to deal with the various problems of the mentally retarded, to counsel their families and to know about and make referrals to available community services. However most also expressed lacks in their knowledge about these various matters. Subsequently, detailed information was sent to them about the available community agencies and then sometime later they were given a second questionnaire concerning their referrals to and advice to parents about the community services. The replies indicated that the physicians now had a much greater awareness of the services available, and that they more regularly made referrals to and advised parents to use these facilities.