Child disobedience and noncompliance: a review

Functional Analysis of Contextually Inappropriate Social Behavior in Children With Down Syndrome

BACKGROUND

Children with Down syndrome often engage in contextually inappropriate social behavior, which researchers suggest may function to escape from difficult activities to preferred social interactions. Caregivers may reinforce the behavior, perceiving it only as evidence of the child's social strength, when, in fact, the pattern may also prevent or slow the development of critical skills. Unlike overt forms of challenging behavior, contextually inappropriate social behavior had never been subjected to experimental analysis.

AIMS

The purpose of the current study was to identify and demonstrate functional control of contextually inappropriate social behavior to caregiver-informed contingencies.

METHOD AND PROCEDURES

We interviewed caregivers and subjected contextually inappropriate social behavior to functional analyses for nine young children with Down syndrome.

OUTCOMES AND RESULTS

We found sensitivity to the caregiver-informed contingencies for all nine participants with strong functional control and large effect sizes for most.

CONCLUSIONS AND IMPLICATIONS

Caregivers may not perceive contextually inappropriate social behavior as problematic, yet patterns of contextually inappropriate and other problem behaviors suggest decreased engagement and poor task persistence. Assessments that lead to intervention decisions may be more informative when they include questions about social topographies of behavior not typically considered as problematic. Once caregivers are aware of the pattern, they may be better prepared to intervene.

Antecedents and Consequences of Child Externalizing Problems: Differences in Dynamic Parent-Child Processes

Given that noncompliance is the most common externalizing problem during middle childhood and reliably predicts significant conduct problems, innovations in elucidating its etiology are sorely needed. Evaluation of in-the-moment antecedents and consequences of child noncompliance improves traction on this goal, given that multiple theories contend that child noncompliance and parent behavior mutually influence each other through negative reciprocation as well as contingent praise processes. Among a sample of 140 families (child age: 6-10 years; 32.1% female), the present study capitalized on intensive repeated measures of observed child noncompliance and parent negative talk and praise objectively coded during three unique tasks. We employed dynamic structural equation modeling to evaluate within-dyad parent-child behavioral dynamics and between-dyad differences therein. Results provided mixed support for hypotheses and suggested that antecedents and consequences of child noncompliance differed according to task demands and child ADHD symptoms. Contrary to models of coercive cycles, during child-led play, parent negative talk was more likely following prior child noncompliance, but child noncompliance was less likely following prior parent negative talk. As expected, during parent-led play, parent praise was less likely following prior child noncompliance, which was also less likely following prior parent praise. Relative to youth with fewer symptoms, for children with elevated ADHD symptoms, during a challenging clean-up task, child noncompliance was less stable and less contingent on prior parent negative talk. Results are discussed in terms of their implications of real-time parent-child interactions for typical and atypical development of externalizing problems.

Challenging behaviour in children with developmental disabilities: an overview of behavioural assessment and treatment methods

Challenging behaviours often co-occur at high rates among those with autism spectrum disorder and intellectual disability. Challenging behaviours, including self-injury, aggression and property destruction, can be associated with social impairment and increased caregiver demands and stress. These behaviours often arise from and are maintained by a combination of biological and environmental risk factors throughout the lifespan. Given the impact of challenging behaviours on development, function-based assessment and intervention approaches are crucial. The prevalence, risk factors, assessment tools and evidence-based treatment options utilised for individuals with developmental disorders are discussed.

Childcare providers' views of challenging child behaviors, suspension, and expulsion: A qualitative analysis

Previous research has underscored a need to understand the experiences and decision-making processes that contribute to suspension and expulsion in early care and education settings, particularly among young children of color. The present study conducted qualitative interviews with 20 center- and family-based childcare providers from the Minnesota Early Care and Education (MECE) study. Participants were asked about challenging child behaviors that they have encountered, their perceptions of these behaviors and how they manage them, and their thought processes around suspension and expulsion. Overall, the most frequently reported categories of challenging behaviors were physical aggression and noncompliance/defiance/arguing. The most commonly reported perceived causes of challenging behaviors were typical child development and parenting problems. The primary reported strategy for addressing challenging behaviors was connecting with the child, with relatively few providers reporting using other evidence-based strategies. Finally, the most commonly reported reasons for considering suspension or expulsion were the providers feeling they had exhausted options and could not meet the child's needs, and the child's behavior being perceived as dangerous to self or others. Implications for future research and practice (including increased support services for childcare providers) are discussed.

Psychometric Assessment of Pilot Language and Communication Items on the 2018 and 2019 National Survey of Children's Health

OBJECTIVE

Until recently, normative data on language and communication development among children in the United States have not been available to inform critical efforts to promote language development and prevent impairments. This study represents the first psychometric assessment of nationally representative data derived from a National Survey of Children's Health (NSCH) pilot measure of language and communication development among children ages 1 to 5 years.

METHODS

We analyzed 14,573 parent responses to language and communication items on the 2018 and 2019 NSCH to evaluate whether the newly added 11 items represent a single latent trait for language and communication development and to determine normative age of success on each item. We applied weighted, one-parameter Item Response Theory to rate and cluster items by difficulty relative to developmental language ability. We examined differential item functioning (DIF) using weighted logistic regression by demographic factors.

RESULTS

Together, exploratory factor analysis resulting in a single factor > 1 and explaining 93% of the variance and positive correlations indicated unidimensionality of the measure. Item characteristic curves indicated groupings were overall concordant with proposed milestone ages and representative of an approximate 90% success cut-point by child age. Indicated normative age cut-points for 3 of the items differed slightly from proposed milestone ages. Uniform DIF was not observed and potential nonuniform DIF was observed across 5 items.

CONCLUSIONS

Results have the potential to enhance understanding of risk and protective factors, inform efforts to promote language and communication development, and guide programmatic efforts on early detection of language delays.

Attachment Representation Moderates the Effectiveness of Behavioral Parent Training Techniques for Children with ADHD: Evidence from a Randomized Controlled Microtrial

Behavioral parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but knowledge on the differential effects of behavioral techniques for specific subgroups of children is very limited. Attachment representations of children with ADHD may affect how receptive children are to changes in parenting. In this study, we investigated whether specific behavioral techniques were more or less effective for children with ADHD in relation to their attachment representations. We included parents of 74 children with ADHD (4-11 years, M = 8.15) who took part in a larger randomized controlled microtrial in which they were randomized to a two session training in antecedent-based techniques (i.e., stimulus control techniques: rules, instructions; n = 26), a two session training in consequent-based techniques (i.e., contingency management techniques: praise, rewards, ignoring; n = 25) or a waitlist control condition (n = 23). We examined whether attachment representation moderated the effectiveness of a) training versus waitlist, and b) antecedent- versus consequent-based techniques. Attachment representations were measured with a story stem task, the intervention outcome was daily parent-rated problem behaviors of the children. Attachment representation did not moderate the effects of the training compared to the waitlist. However, compared to antecedent-based techniques, consequent-based techniques were less effective for more securely and less disorganized attached children, and particularly effective for more disorganized attached children. This was the first study examining attachment as a moderator of behavioral techniques for ADHD. If replicated, the findings of this study can be used for treatment development and tailoring.

Parental self-efficacy and satisfaction with parenting as mediators of the association between children’s noncompliance and marital satisfaction

Parents of young children who exhibit behavioral problems often experience lower marital satisfaction. In the present study we aimed to explore the association between preschool children's noncompliant behavior and marital satisfaction, and to explain it through the mediating role of parental self-efficacy and satisfaction with parenting. Participants were 188 married Israeli couples with a typically developing child aged 3 to 6, selected in a convenience sample. Mothers and fathers independently completed measures of child’s behavior, marital satisfaction, parental self-efficacy, and satisfaction with parenting. Data were collected between September 2019 and February 2020 and were analyzed using the common fate model (CFM). Results indicate a direct, negative association between child's noncompliant behavior and marital satisfaction, which was fully explained by parental self-efficacy and satisfaction with parenting. The study suggests that both parents are affected by their young child’s noncompliance, with a spillover effect from the parent–child relationship into the marital relationship. The findings highlight the importance of early treatment of children's noncompliance and indicate that interventions aimed at enhancing parents’ self-efficacy and satisfaction, as well as the inclusion of both parents in treatment, may be beneficial.

Parenting behaviors of mothers with posttraumatic stress: The roles of cortisol reactivity and negative emotion

Although posttraumatic stress disorder (PTSD) is associated with negative family outcomes, including parenting challenges, little is known about the biological and emotional processes that might underlie this association. The present project addressed this gap by examining associations between maternal PTSD and parenting behaviors in a lab setting. We expected that PTSD would be associated with more ineffective parenting behaviors and that negative emotion and cortisol reactivity would mediate this relation. A total of 78 mothers and their toddler-aged children completed a task designed to elicit parental responses to typical instances of child misbehavior. Salivary cortisol was collected from mothers prior and subsequent to the lab paradigm and mothers provided ratings of their experienced emotion while viewing a video of the interaction. Contrary to hypotheses, cortisol reactivity did not mediate associations between PTSD and parenting. However, findings suggest that PTSD is associated with greater permissive parenting behaviors, and mothers with even subthreshold symptoms of PTSD may experience more negative emotion during challenging parent-child interactions that ultimately interferes with parenting. Mothers with PTSD may benefit from interventions that focus on modifying the intensity of their negative emotions in the context of child misbehavior to more effectively set limits in everyday discipline encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Confirmation of a Reconceptualized Definition and Measure of Adolescent Risk Behavior: Adolescent Viewpoints

The goal of this project was to substantiate a more positive conceptualization of adolescent risk behavior and to compare adolescent viewpoints of risk behavior to the items on the Prosocial and Health Adolescent Risk Behavior Scale (PHARBS). A total of 57 high school students participated in the research. Researchers recruited students from an Advanced Placement (AP) Psychology course at a large Midwestern high school. The high school serves approximately 1,750 students in grades 9 through 12. The university Institutional Review Board approved the study procedures. Families provided informed consent, and students assented to participating in one of eight focus group discussions. The focus groups were audio taped, transcribed, and coded. Researchers analyzed the coded data using word count analysis. Students discussed prosocial risk behaviors in addition to health risk behaviors, providing support for the PHARBS and suggesting that adolescents view taking some risks as positive. A more positive conceptualization of risk behavior may better align with how adolescents view risk behavior. Researchers and clinicians might approach adolescent risk behavior measurement and research on the importance of understanding risk behaviors as a normal and potentially positive aspect of adolescent development.

Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

OBJECTIVE

Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT.

METHOD

In a three-armed randomized controlled microtrial including parents of 92 children (4-12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects.

RESULTS

Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 (d= .56) and T2 (d= .65); in the CC, these behaviors only improved at T2 (d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions.

CONCLUSIONS

Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.

Teenagers and Young Adults with Cancer: An Exploration of Factors Contributing to Treatment Adherence

This systematic appraisal explores the literature surrounding treatment adherence in teenagers and young adults (TYAs) with cancer, with the aim of identifying influential factors that could affect adherence rates. This area is particularly important due to the increased risk of relapse and death associated with nonadherent behavior. In addition, TYAs are found to be the age group least likely to adhere to medical regimes. A comprehensive review of the literature was conducted and seven studies met the inclusion criteria, the articles were then critiqued using a data extraction form and eight themes were generated and discussed. This review highlights the complexities and difficulties in measuring adherence, as well as the key factors affecting adherence, before identifying implications for practice. Good communication and relationships are crucial between all parties involved in TYAs’ care including the patients, professionals, parents, and peers. A model of adherence was adapted on the basis of the result of the systematic review, other literature pertaining to adherence in TYAs, and the clinical experience of the authors. Personal factors and external factors, along with treatment factors and interactions with the system all have an effect on the patient's response or ability to adhere. It is apparent that there is a need for more high-quality qualitative and quantitative research in this area, with an emphasis on finding interventions that directly improve adherence specific to this age group.

Evaluation of the high-probability instructional sequence to increase compliance with multiple low-probability instructions among children with autism

The high-probability (high-p) instructional sequence typically consists of the delivery of a series of high-p instructions immediately followed by the delivery of a low-probability (low-p) instruction and is a commonly used procedure to increase compliance among children with intellectual disabilities. In the current study, we used withdrawal designs to evaluate the use of the high-p sequence to increase compliance with a series of 2 or 3 low-p instructions among 3 children with autism. The sequence was moderately effective in increasing compliance with all low-p instructions for 2 participants. Compliance exhibited by the 3rd participant, for whom the high-p sequence was ineffective, increased when differential reinforcement was delivered. We discuss the utility of the high-p sequence to increase compliance with multiple instructions and the putative mechanisms responsible for the effects of the sequence.

Further analysis of modifications to the three-step guided compliance procedure to enhance compliance among children with autism

Three-step guided compliance (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) is a commonly used procedure to increase compliance among children with intellectual disabilities. Previous research has suggested that under some conditions, slight modifications to the three-step procedure may enhance its effectiveness. These modifications include omitting the model prompt and decreasing the interprompt interval. In the current study, we evaluated another modification to the procedure: the delivery of a high-preference item contingent upon compliance with the first vocal prompt (i.e., differential reinforcement). For 2 participants with autism, compliance remained low when we implemented differential reinforcement and the guided compliance procedure in isolation. However, compliance improved when we combined differential reinforcement and the three-step guided procedure, suggesting that for at least some children, the combination of contingent access to a high-preference item and the guided compliance procedure is more effective than either intervention alone.

Differential physiological sensitivity to child compliance behaviors in abusing, neglectful, and non-maltreating mothers

We examined time-ordered associations between children's compliance behavior and maternal respiratory sinus arrhythmia (RSA) in a sample of 127 child-maltreating (physical abuse, physical neglect, emotional abuse) and 94 non-maltreating mothers and their preschool-aged children. Child prosocial and aversive compliance behaviors and maternal RSA were continuously collected during a joint challenge task. Child behavior and mother RSA were longitudinally nested within-person and subjected to multilevel modeling (MLM), with between-person child maltreatment subtype and level of inconsistent parenting modeled as moderators. Both child maltreatment type and inconsistent parenting moderated the effects of child compliance on maternal RSA. Increases in children's prosocial compliance behaviors led to decreasing RSA in physically abusive mothers 30s later (i.e., increasing arousal), but predicted increases in non-maltreating mothers' RSA (i.e., increasing calm). Inconsistent parenting (vacillating between autonomy-support and strict control) also moderated the effects of children's compliance behavior on maternal physiology, weakening the effects of child prosocial compliance on subsequent maternal RSA. These findings highlight variations in mothers' physiological sensitivity to their children's prosocial behavior that may play a role in the development of coercive cycles, and underscore the need to consider individual differences in parents' physiological sensitivity to their children to effectively tailor interventions across the spectrum of risk.

Structural validity of the Parenting Daily Hassles Intensity Scale

Although the Parenting Daily Hassles Intensity Scale is a common measure, it has been relatively unclear whether users should employ the 15-item form that quantifies routine parenting hassles on two dimensions of intensity or the 20-item form that assumes a single dimension underlies the responses on the scale. To help address this gap, Bayesian confirmatory factor analysis was used to investigate the structural validity of the 15- and 20-item forms in a sample of 174 mothers with at least one young child ( x ¯  = 6.040, SD = 0.492). Results of the Bayesian analysis did not provide empirical support for either form. A subsequent exploratory factor analysis indicated that six of the hassles that appear to address challenging child behaviour tended to cluster onto one latent factor whereas 11 hassles that appear to speak to routine parenting chores tended to cluster onto a second factor. A follow-up Bayesian analysis indicated that intensity scores can be approximated well under the 17-item form (ppp = 0.124). Accordingly, researchers and clinicians are encouraged to consider the 17-item form when addressing their measurement needs.

Understanding and Parenting Children's Noncompliant Behavior: The Efficacy of an Online Training Workshop for Resource Parents

The current study examined the effectiveness of an online training program on parenting children's noncompliant behavior. Eighty-two resource parents (foster, adoptive, and kinship) were recruited through Foster Parent College-an online training website-and randomly assigned to a treatment or wait-list control group. Parents in the treatment group participated in an online interactive workshop on noncompliant child behavior. Online assessments occurred before and after a 1-week intervention, and again 3 months later. Group differences at posttest were significant for parents' reports of children's positive behavior and parent knowledge related to children's noncompliant behavior. Only parents in the treatment group showed significant improvement from pre- to posttest on several other outcome measures of parenting noncompliant behavior. Satisfaction with the online workshop at posttest was very high. Results at the 3-month follow-up assessment showed significant group differences only for parents' knowledge about children's noncompliant behavior. Feedback on the workshop remained positive, with treatment group parents indicating that they felt the workshop had beneficially impacted their parenting and their children's behavior.

Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

Self-Regulation Assessment Based on Compliance and Noncompliance in Children

En este trabajo llevo a cabo una reflexión acerca de la información que los comportamientos de cumplimiento e incumplimiento nos brindan acerca del desarrollo de la autorregulación en los niños. Sostengo que las diferencias que estos comportamientos revelan en cuanto a la autorregulación dependen del nivel de autonomía de los niños, su motivación y la activación emocional que demuestran cuando desobedecen. Sugiero también algunas metodologías para valorar cada uno de estos factores. Específicamente, propongo diferenciar entre los distintos tipos de cumplimiento e incumplimiento, registrar de manera simultánea el comportamiento de los niños y el tipo de control ejercido por los padres y analizar el comportamiento con el que responden los niños a exigencias legítimas e ilegítimas. Estas distinciones son importantes para un abordaje más completo y preciso del estudio de la autorregulación en los niños

Deconstructing noncompliance: parental experiences of children's challenging behaviours in a clinical sample

PURPOSE

This study explored the phenomenon of children's nonconforming behaviours from the perspective of parents who sought clinical services for children's severe noncompliance.

METHOD

Mothers from 25 families who accessed clinical services were interviewed about their relationship with their children aged 8-13 and their experiences of their children's challenging behaviours.

RESULTS

Mothers distinguished two different types of challenging behaviour: normative resistance and extreme aggression. Mothers described normative resistance as an expected part of children's developing autonomy and treated resistance with behavioural management strategies. Mothers also described occasions when children displayed emotionally dis-regulated extreme aggression, which were consistent with clinical descriptions of children's difficult to manage behaviour.

CONCLUSION

Contrary to clinical recommendations mothers used relational strategies to reconnect children with their agency. The distinction between two different child behaviours, and strategies for each challenging behaviours have theoretical and practical implications.

Reliability and Validity of a New Comprehensive Tool for Assessing Challenging Behaviors in Autism Spectrum Disorder

OBJECTIVE

The purpose of this study was to examine the validity and reliability of the Korean Comprehensive Scale for the Assessment of Challenging Behavior in Developmental Disorders (K-CSCB).

METHODS

In total, the parents of 189 patients with autism spectrum disorder (ASD) and 168 controls completed the K-CSCB, the Behavior Problems Inventory (BPI) and Child Behavior Checklist (CBCL). The reliability and validity of the K-CSCB was investigated.

RESULTS

The K-CSCB was found to be a reliable instrument (Cronbach's α=0.97). There was a significant difference between the ASD and control groups in all subscale scores. Scores on the K-CSCB subscales were significantly correlated with those on the BPI and CBCL. The diagnostic validity was 97.7%, and the cut-off score with the highest sensitivity and specificity was 12.5 points.

CONCLUSION

The K-CSCB is the first tool in Korean to assess problematic behavior in individuals with ASD, and this study shows that it is a valid and reliable instrument. We expect the K-CSCB to be widely used in clinical and research settings.

Evaluation of a preliminary method to examine antecedent and consequent contributions to noncompliance

We evaluated a preliminary method for examining the antecedent and consequent contributions to noncompliance exhibited by two children with disabilities. In Phase 1, we assessed whether noncompliance was a result of a skill deficit. For one participant, we then conducted a functional analysis to determine the variables maintaining noncompliance in Phase 2. In Phase 3, we conducted a treatment evaluation to increase compliance for each participant. We identified the antecedent and consequent variables responsible for noncompliance and developed an effective intervention for both participants.

Dealing with Disobedience: An Evaluation of a Brief Parenting Intervention for Young Children Showing Noncompliant Behavior Problems

The study was a randomized controlled trial evaluating the efficacy of a brief and preventatively-focused parenting discussion group for dealing with disobedient behavior in preschool-aged children. Eighty-five parents with children aged between 3 and 5 years who were concerned about the noncompliant behavior of their child were recruited from Auckland, New Zealand and Brisbane, Australia. Compared to the waitlist control group (n = 40), parents in the intervention group (n = 45) reported greater improvements in disruptive child behavior, ineffective parenting practices and parenting confidence, as well as clinically significant improvements in child behavior and parenting. All of these effects were maintained at 6-month follow up. No group differences were found for parental wellbeing, inter-parental conflict and general relationship quality, although intervention parents reported improvements in parental wellbeing and inter-parental conflict at 6-month follow-up. The findings are discussed in terms of the implications for making brief and effective parenting support available to parents.

Relations between rate of negative reinforcement and the persistence of task completion

Research has shown that differential reinforcement of alternative behavior (DRA) can be an effective intervention to address problem behavior maintained by negative reinforcement emitted by young children. However, few studies have evaluated the variables that are related to long-term maintenance (i.e., persistence) of treatment effects. Research on behavioral persistence predicts that the rate of reinforcement provided for a target behavior is correlated with its persistence when challenged. There were 2 purposes of the current investigation. First, we evaluated the effects of the rate of negative reinforcement on the persistence of task completion. Second, we applied the findings regarding rate of reinforcement to a treatment context for 3 participants who engaged in destructive behavior that was reinforced by escape from demands. Results were evaluated within a multielement design and indicated that the rate of negative reinforcement had a moderate influence on the persistence of task completion. These results contribute to the existing literature by extending analyses of persistence to treatment contexts.

Parenting and the behavior problems of young children with an intellectual disability: concurrent and longitudinal relationships in a population-based study

We examined parenting behaviors, and their association with concurrent and later child behavior problems. Children with an intellectual disability (ID) were identified from a UK birth cohort (N  =  516 at age 5). Compared to parents of children without an ID, parents of children with an ID used discipline less frequently, but reported a more negative relationship with their child. Among children with an ID, discipline, and home atmosphere had no long-term association with behavior problems, whereas relationship quality did: closer relationships were associated with fewer concurrent and later child behavior problems. Increased parent-child conflict was associated with greater concurrent and later behavior problems. Parenting programs in ID could target parent-child relationship quality as a potential mediator of behavioral improvements in children.

An evaluation of evidence-based interventions to increase compliance among children with autism

We evaluated 4 evidence-based interventions to increase compliance. Three children with autism who exhibited noncompliance when asked to relinquish a preferred toy were exposed sequentially to interventions that included a reduction in response effort, differential reinforcement, and guided compliance. Results indicated that effort reduction alone was ineffective and that each participant's compliance improved after exposure to a different intervention; these results highlight the need to individualize treatments for compliance.

Evaluation of a brief parenting discussion group for parents of young children

OBJECTIVE

Although behavioral parenting programs are effective at treating child behavioral problems, a significant number of parents experiencing these problems do not receive help, and briefer, more cost-effective parenting interventions are lacking. This study aimed to evaluate the efficacy of a brief parenting discussion group.

METHOD

Sixty-seven parents were randomly assigned to either an intervention or waitlist control condition. Parents in the intervention condition took part in a 2-hour discussion group in which they were taught positive parenting strategies to prevent and manage their child's disobedience, and they received 2 follow-up telephone calls after the discussion group.

RESULTS

Results showed that after intervention, there were reductions in child behavior problems and use of dysfunctional parenting and improvements in parental self-efficacy and the parenting experience for parents. These effects were maintained at 6-month follow-up.

CONCLUSION

The results are promising because they show that a brief intervention can be minimally sufficient to improve child and parent outcomes for parents experiencing high levels of child behavior problems.

Behaviour regulation at the family dinner table. The use of and response to direct and indirect behaviour regulation in ten Swedish families

This study explores parents' and children's use of and response to direct or indirect behaviour regulation in a family context. Ten families with two children each were divided into two groups depending on the age of the children (6-7 and 10-11 years or 10-11 and 13-14 years). Video-recorded regulatory dinner talk was transcribed, coded and analysed with regard to directness or indirectness in relation to behavioural outcome. Dinner talk was predominantly direct, but younger children were addressed by direct regulators as two-thirds of all regulators, whereas the opposite was seen with older children. Though children also tended to be direct, younger children used three times as many direct regulators as older ones. Compliance appeared in two-thirds of all direct regulators, but almost one-half of all indirect regulators were not complied with. Differences between groups were furthermore distinguished by instances of compliance: those who were most non-compliant were the children in group 2.

Assessment of the relative effects of attention and escape on noncompliance

The current study presents a method for assessing the relative effects of attention and escape on noncompliance in preschoolers. Attention and escape conditions were alternated in a multielement design, and a contingency reversal procedure, in which one test condition served as a control for the other, was used to demonstrate control. For all 3 participants, noncompliance was maintained, at least in part, by social attention. Functional analyses of noncompliance such as the one described here may be valuable for developing function-based treatments.

Sibling supervision and young children's risk of injury: a comparison of mothers' and older siblings' reactions to risk taking by a younger child in the family

Although parental supervision is associated with reduced risk of injury to young children, supervision by older siblings has been shown to increase this risk. The current study, conducted in Guelph, Canada, explored how this differential risk of injury may arise. It compares the supervision behaviors of mothers to those of their older children when each was the designated supervisor of a young child, shown on a videotape to engage in no risk, risk, and rule violation behaviors in a home situation. The mothers and older child supervisors were told to imagine the toddler on the videotape was the young child in their own family, and to stop the tape and speak to the child whenever they would in real life. Results indicated that supervisees were allowed to engage in more risk behaviors when supervised by older siblings than by mothers. Sibling supervisors reacted to risk behaviors with more prohibitions, whereas mothers adopted a teaching orientation and gave more explanations and directions in response to risk behaviors by the supervisee. Implications for injury prevention and directions for future research are discussed.

Development and etiology of disruptive and delinquent behavior

This review examines the development and etiology of disruptive behavior [symptoms of oppositional defiant disorder (ODD), conduct disorder (CD), and psychopathic features] and delinquency (particularly violence). We address selected key developmental issues, including (a) to what extent negative emotional ODD symptoms are associated with later internalizing disorders, (b) whether psychopathic features provide added predictive utility beyond traditional disruptive behaviors, and (c) the role of oppositional behavior and conduct problems in the development of violence. This review also focuses on the causes of ODD, CD, psychopathic features, and delinquency and explores the extent to which the causes of disruptive and delinquent behavior are the same. We examine the degree to which risk and promotive factors change with age and whether promotive factors buffer the impact of risk factors. Finally, we explore the question of whether there are developmental shifts in children's exposure to risk and promotive factors.

Maternal punishment practices in a rural area of Turkey

OBJECTIVE

We examined a number of maternal characteristics that influence punishment practices in a rural area of Turkey.

METHODS

Questionnaires were filled out in face-to-face interviews with 539 mothers who agreed to participate in this study.

RESULTS

The majority findings of this study were as follows: all of the mothers had used various forms of punishment on their children; hitting other children was the primary reason for punishment, and hitting was the most common form of punishment used by mothers. Another interesting finding of this study was that mothers did not demonstrate the same responses to their children when they were alone as when others were present. Mothers commonly felt regret in the post-punishment period.

CONCLUSION

These findings can be useful in establishing parental educational programming that is directed at decreasing the rates of punishment practices.

Effects of antecedent variables on disruptive behavior and accurate responding in young children in outpatient settings

The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to evaluate their influence on disruptive behavior. With a 3rd child, similar procedures were employed at school. Results showed one-step directives set the occasion for accurate responding and that other dimensions of the task (e.g., preference) functioned as motivating operations for negative reinforcement.

Medication Noncompliance and its Implications in Transplant Recipients

The transplant patient's therapeutic regimen consists of a lifelong drug therapy, including immunosuppressive drugs, prophylactic antimicrobials and often medications for the treatment of hypertension, diabetes mellitus and other comorbid diseases. Regular clinic appointments are required to monitor for signs and symptoms of immunological injury, recurrent disease and adverse drug effects. Patients are instructed to avoid risk factors for cardiovascular disease and cancer (e.g. diet, exercise, sun protection and not smoking). Noncompliance with all aspects of this regimen is substantial. Medication noncompliance leads to an increased incidence of acute rejection, chronic rejection and graft loss. Undoubtedly, many practitioners fail to appreciate the extent of noncompliance as the signs are often subtle and most patients are unwilling to disclose deliberate or widespread disregard for medication use. Newer immunosuppressive agents, particularly once-daily medications and long-acting antibody preparations offer convenience and monitoring that may improve compliance. This review focuses on the prevalence, correlates and consequences of medication nonadherence after organ transplantation. Current recommendations to enhance adherence are discussed.

Externalizing and oppositional behaviors and karate-do: the way of crime prevention. A pilot study

Childhood disruptive behaviors can be precursors to later deviance. To verify the efficacy of karate, a complex psychomotor activity that enhances self-regulation and executive skills, as an intervention for externalizing behaviors, 16 children, ranging in age from 8 to 10 years, and meeting diagnostic criteria for oppositional defiant disorder were studied. Eight were randomly assigned to a 10-month Wa Do Ryu karate program, whereas 8 children received no intervention. The children were assigned to a larger karate class, composed of typically developing youngsters. Three domains of temperament--intensity, adaptability, and mood regulation--were measured at the beginning and the end of the training period in all 16 participants. A significant improvement in temperament scale scores was measured in the karate group for all tested items compared to controls. Karate, when properly taught, can be a useful adjunct in multimodal programs aimed at externalizing behavior reduction.

Perceptions of inner city parents about early behavioral and violence prevention counseling

OBJECTIVES

(1) Identify how receptive inner city parents of young children are to routine anticipatory guidance about behavior at well child care visits. (2) Determine whether inner city parents correlate early behavior problems with a risk of later behavior problems. (3) Determine whether inner city parents believe that physician-provided anticipatory guidance about behavioral issues and violence prevention can help their child avoid future violence-related problems.

METHODS

A convenience sample of parents of children < or =5 years old attending an inner city pediatric teaching clinic were invited to complete a self-administered survey including questions about behavior, parenting, and physician-provided behavior and violence counseling.

RESULTS

One hundred and ninety-five participants completed surveys; most were African-American (81%) mothers (92%). In response to T/F questions, 84% of parents responded "False" to "Bad behavior in kids cannot be prevented" (95% CI; 78.8, 89.1), 97% responded "False" to "[Bad behavior in kids] cannot be changed" (95% CI; 94.5, 99.3), and 67% responded "True" to "My child's doctor can help me protect my child from violence" (59.8, 73.6). A majority of parents indicated that doctors should routinely ask about behavior and discuss parenting even if the parent was not worried about their child's behavior.

CONCLUSIONS

Inner city parents believe that bad behavior in children can be changed and prevented. They welcome physician-provided guidance about behavior and believe physicians can help their children avoid violence.

Medication non-adherence in the adolescent renal transplant recipient: a clinician's viewpoint

Recent advancements in immunosuppression and surgical techniques have significantly improved the outcome of kidney transplantation in the pediatric population. Adolescents enjoy the best 1-year graft survival of any age group. However, the long-term transplant outcome in adolescents is disappointing. Non-adherence with immunosuppressive medications is one of the most important contributing factors for graft rejection and loss in teenagers. The impact of non-adherence is perceived to be far more powerful in adolescent transplant recipients than in the transplant population as a whole. To better understand adolescent non-adherence, the process of transplantation must be placed in the context of adolescent development. Adolescents try to establish their identity and autonomy separately from the parents; however at the same time, adolescents with chronic illness require help, support and guidance from adults, including parents and medical personnel. Adolescents have limited ability to anticipate abstractly the long-term consequences of their immediate actions. This inconsistency can create frustration in both adolescents and in the supporting systems around them. Despite the significant consequences of adolescent non-adherence, research in this area is scarce. There are still no established definitions, standardized diagnostic methods and effective interventions to treat and prevent this problem. We propose the recommendations to approach the problems of adolescent transplant non-adherence from the transplant clinician's viewpoint. With early identification and appropriate interventions, significant improvement in adolescent graft survival is possible.

Noncompliance with immunosuppressive medications in pediatric and adolescent patients receiving solid-organ transplants

Advances in knowledge in transplantation have improved 1-year renal allograft survival in all age groups of pediatric patients. However, the results from many studies have shown that the long-term allograft survival is least successful in adolescent recipients. The major cause of late graft failure in adolescents can be contributed in large measure to medication noncompliance. Medication noncompliance in teenagers has been shown to be more than four times greater in adolescents than in adults. The teenage years are a time of transition from childhood to adulthood. Important tasks during this transition include the development of an autonomous identity that progresses to full independence. However, the cognitive skills and intellectual maturation of adolescents are still limited, and this is particularly true in adolescents with chronic diseases. They have difficulty with abstract thinking, particularly the conceptualization of future consequences of present actions. This leads to characteristic risk-taking behaviors, including noncompliance with medical treatments. This transition is more intricate for adolescents with chronic illness because of their physical limitations. There are a number of strategies that are helpful in mitigating noncompliance. Adolescents must be dealt with directly. Previous noncompliant behaviors need to be acknowledged and dealt with, because studies show that noncompliance is a "stable" personality attribute that persists over time. Efforts should be made to choose medications that have the least side effects. Psychological and psychiatric conditions such as posttraumatic stress disorder require early recognition, diagnosis, and treatment. It is necessary to build rapport with teenagers, and this should start before transplantation. A multidisciplinary approach with physicians, social workers, nurses, and transplant coordinators is an effective mean of enhancing compliance. These and other strategies outlined in this discussion will enable the adolescent to achieve good compliance rates and prevent graft loss.