Reinforcement of compliance with respiratory treatment in a child with cystic fibrosis

Increasing passive compliance to wearing a facemask in children with autism spectrum disorder

The current study taught 6 children with autism spectrum disorder (ASD) to increase passive compliance of wearing a facemask across sequentially increasing durations of time. A changing-criterion design embedded within a nonconcurrent multiple baseline design was used to evaluate the effectiveness of a resetting differential reinforcement of other behavior (DRO) without escape extinction procedure on passive compliance. Terminal probe sessions determined DRO fading intervals. Results showed that 2 participants acquired mastery level passive compliance (30 min) without fading during the initial baseline sessions. The remaining 4 participants acquired mastery level passive compliance following fading intervals within the DRO intervention. Participants' passive compliance generalized across 2 novel settings. This study replicates previous studies and extends empirical support for the use of DRO without escape extinction interventions for increasing passive compliance with medical devices in children with ASD.

Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention

This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.

An evaluation of differential reinforcement with stimulus fading as an intervention for medical compliance

Individuals with autism spectrum disorder (ASD) often exhibit noncompliance during medical exams. One intervention used to address this concern is differential reinforcement. Although differential reinforcement includes extinction, it may not be feasible or safe to implement extinction during medical exams. In the current study, we evaluated differential reinforcement without extinction and differential reinforcement without extinction plus stimulus fading, for increasing compliance during routine medical exams exhibited by 4 individuals with ASD. An indirect assessment identified problematic medical procedures, and a functional analysis showed that participants' disruptive behavior was maintained by escape from medical tasks. Differential reinforcement without extinction was insufficient in increasing medical compliance with 3 of 4 participants. The addition of a modified stimulus fading procedure that involved gradually introducing smaller components of problematic exam steps was effective in increasing medical compliance with all exam steps.

OB CITY-Definition of a Family-Based Intervention for Childhood Obesity Supported by Information and Communication Technologies

Childhood obesity is becoming one of the 21st century's most important public health problems. Nowadays, the main treatment of childhood obesity is behavior intervention that aims at improve children's lifestyle to arrest the disease. Information and communication technologies (ICTs) have not been widely employed in this intervention, and most of existing ICTs systems are not having a long-term effect. The purpose of this paper is to define a system to support family-based intervention through a state-of-the-art analysis of family-based interventions and related technological solutions first, and then using the analytic hierarchy process to derive a childhood obesity family-based behavior intervention model, and finally to provide a prototype of a system called OB CITY. The system makes use of applied behavior analysis, affective computing technologies, as well as serious game and gamification techniques, to offer long term services in all care dimensions of the family-based behavioral intervention aiming to provide positive effects to the treatment of childhood obesity.

Developmental and psychosocial issues in cystic fibrosis

Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.

Developmental and psychosocial issues in CF

Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted.

The efficacy of adherence interventions for chronically ill children: a meta-analytic review

OBJECTIVES

To provide quantitative information about the overall effectiveness of adherence interventions to improve adherence and health outcomes for children with chronic illnesses. To evaluate statistically the potential moderators.

METHODS

A meta-analysis was performed on 71 adherence intervention studies.

RESULTS

Weighted-mean effect size (ES) across all the adherence outcomes for group design studies was in the medium range (mean d = 0.58) and for single-subject design studies was in the large range (mean d = 1.44). The weighted mean ES across all health outcome measures for studies using group designs was in the medium range (mean d = 0.40) and for studies using single-subject designs was in the large range (mean d = 0.74).

CONCLUSIONS

Adherence interventions for children with chronic illnesses effectively increase adherence and result in some positive health benefits. Intervention and methodological variables had significant impact on ESs. High levels of heterogeneity characterized the data.

Using quality improvement science to implement a multidisciplinary behavioral intervention targeting pediatric inpatient airway clearance

OBJECTIVE

The objective of this study was to use quality improvement science methodology to develop a multidisciplinary intervention improving occurrence of best-practice airway clearance therapy (ACT) in inpatient adolescents with cystic fibrosis during routine clinical care.

METHODS

The model for improvement was used to develop and implement interventions. Primary outcomes were quality of ACT (% ACT meeting criteria for best practice) and quantity of ACT (% of hospital days patients received ACT four times/day). Annotated control charts were used to document the impact of the interventions.

RESULTS

Quality of ACT significantly improved from 21% best practice ACT at baseline to 73%. Quantity of ACT significantly improved from 41% days with ACT four times/day at baseline to 64%.

CONCLUSIONS

A multidisciplinary, evidence-based intervention was effective for improving occurrence of best-practice ACT. Pediatric psychology can make valuable contributions to improving the quality of care provided in the medical setting.

A token economy for exercise adherence in pediatric cystic fibrosis: a single-subject analysis

OBJECTIVE

In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF.

METHODS

An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise.

RESULTS

Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants.

CONCLUSIONS

A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.

Compliance of children with moderate to severe intellectual disability to treadmill walking: a pilot study

BACKGROUND

Individuals with Intellectual Disability (ID) exhibit reduced levels of compliance to exercise, including treadmill walking. The purpose of this study was to measure the effects of several training conditions on compliance to participation in treadmill walking of children with moderate to severe ID.

METHOD

Criteria for compliance were the averaged number of times participants attempted to discontinue walking during two 5-min exercise sessions of treadmill walking at an intensity of 65-75% of predicted maximal HR. Fifteen children aged 5-11 with moderate to severe ID participated in the study. Training conditions were (a) close supervisor's position, (b) distant supervisor's position, (c) positive reinforcement, and (d) paired modeling.

RESULTS

General linear mixed model statistics revealed significant differences in favor of the paired modeling and positive reinforcement compared to the other conditions. Leaning forward was the most frequent type of participants' attempt to stop exercising.

CONCLUSIONS

Paired modeling and positive reinforcement should be considered within treadmill training programs for children with moderate to severe ID.

Shaping academic task engagement with percentile schedules

The purpose of this study was to examine the use of percentile schedules as a method of quantifying the shaping procedure in an educational setting. We compared duration of task engagement during baseline measurements for 4 students to duration of task engagement during a percentile schedule. As a secondary purpose, we examined the influence on shaping of manipulations of the number of observations used to determine the criterion for reinforcement (the m parameter of the percentile formula). Results showed that the percentile formula was most effective when a relatively large m value (20 observations) was used.

Increasing adherence to cystic fibrosis treatment: a systematic review of behavioral techniques

Cystic fibrosis is a fatal chronic illness that primarily affects the respiratory and pancreatic systems. Treatment includes daily medications, enzyme and vitamin supplements, a high-calorie diet, and airway clearance sessions (e.g., chest physiotherapy, exercise). Although this regimen is essential to longevity, families have difficulty adhering to the multiple treatment components. Adherence is especially problematic with diet, chest physiotherapy, and exercise. Studies utilizing behavioral techniques to increase adherence to cystic fibrosis treatment components have been conducted with varying results. In this paper, a critical review of these treatment studies and suggestions for future work are presented.

The effects of extinction, noncontingent reinforcement and differential reinforcement of other behavior as control procedures

Several techniques have been used in applied research as controls for the introduction of a reinforcement contingency, including extinction, noncontingent reinforcement (NCR), and differential reinforcement of other behavior (DRO). Little research, however, has examined the relative strengths and limitations of these "reversal" controls. We compared the effects of extinction with those of NCR and DRO in both multi-element and reversal designs, with respect to (a) rate and amount of response decrement, (b) rate of response recovery following reintroduction of reinforcement, and (c) any positive or negative side effects associated with transitions. Results indicated that extinction generally produced the most consistent and rapid reversal effects, with few observed negative side effects.