A behavioral-educational alternative to drug control of hyperactive children

Using an App-Based Token Economy to Increase Engagement in Daily Living and Vocational Tasks with Adults with Developmental Disabilities

The token economy is an evidence-based practice that improves outcomes across populations, settings, and behaviors. Nonetheless, their complex nature frequently leads to ineffective implementation. In addition, little is known about the extent to which token economies are effective for increasing engagement in adults with disabilities. Therefore, we conducted a multiple probe across participants to evaluate the effectiveness of a token economy using an app (i.e., Class Dojo) to increase engagement with daily living and vocational tasks in adults with disabilities. All participants increased their engagement with tasks following the introduction of the intervention and maintained higher than baseline levels of engagement up to 6 weeks after the intervention ended. Staff members completed an anonymous survey to indicate their perception of the feasibility and effectiveness of the intervention. Social validity results indicated that some staff members found the intervention effective, but time-consuming and challenging.

Reinforcement Contingency Learning in Children with ADHD: Back to the Basics of Behavior Therapy

Reinforcement deficits in ADHD may affect basic operant learning processes relevant for Behavioral Treatment. Behavior acquired under partial reinforcement extinguishes less readily after the discontinuation of reinforcement than behavior acquired under continuous reinforcement, a phenomenon known as the Partial Reinforcement Extinction Effect [PREE], which has great relevance for the emergence of behavioral persistence. The present study examined acquisition and extinction of operant responding under partial and continuous reinforcement in children with and without ADHD. In addition, we evaluated the effectiveness of gradual stretching the reinforcement rate during acquisition for remedying potential acquisition or extinction deficits under partial reinforcement in ADHD. In an operant learning task designed to mimic the task confronted by an animal in a Skinner box, 62 typically developing and 49 children with ADHD (age: 8–12) were presented with a continuous, partial or gradually stretching reinforcement scheme followed by extinction. Both groups of children acquired the instrumental response more slowly and exhibited more behavioral persistence (reduced extinction) when responding was initially reinforced under partial relative to continuous reinforcement, with no differences between groups. Progressive ratio stretching resulted in faster acquisition than partial reinforcement yet promoted equal behavioral persistence, again without differences between ADHD and TD groups. Unlike suggested by previous research, children with ADHD exhibit neither an acquisition deficit under partial reinforcement nor a deficit in PREE. Of relevance for Behavioral Treatment, gradual reinforcement stretching can be used to facilitate response acquisition over purely partial reinforcement while maintaining equal behavioral persistence upon reward discontinuation.

Student Ability, Task Difficulty, and Inappropriate Classroom Behavior

The purpose of this study was to examine the effect of a mismatch between student ability and task difficulty upon inappropriate classroom behavior in children with behavior disorders. The mismatch condition was evaluated both with and without a reinforcement contingency on task accuracy. An experimenter-constructed pretest was used to assess the level of math functioning in the 15 subjects. Variations on the A-B—a single-subject experimental design were used to evaluate the independent variables. An increase in inappropriate behavior was found during the mismatch condition both with and without a reinforcement contingency on task accuracy. Results suggested that failure-level academic tasks resulted in significant increases in inappropriate behavior for some students. Implications of this study for special educators are discussed.

Improving Environments for Profoundly Handicapped Adults

A common problem in settings for profoundly handicapped adults is the generally low level of client participation with their environment. Within a Special Needs Day Unit for profoundly handicapped young adults, a procedure was developed by which staff could increase client participation. One staff member, designated as Room Manager, ensured that a selection of material was available for each trainee, briefly prompted trainees to begin working with the materials, and provided positive attention differentially to those who were engaged. This procedure was compared with a common alternative; staff prompted trainees who were not engaged, but otherwise let them work undisturbed except to stop major disruptions. The Room Manager procedure was considerably more effective in increasing and maintaining the level of trainee engagement than the alternative. It also freed other staff members to work with trainees on an individual basis. Followup data indicated that, with appropriate monitoring, staff were able to maintain the use of this procedure. Therefore, the Room Manager procedure provides a basis for conducting and maintaining activity periods in settings for profoundly handicapped people.

Physical Exercise as a Reinforcer to Promote Calmness of an ADHD Child

Age-appropriate reinforcers have been found to be effective in promoting attentiveness and calmness with children with attention deficit hyperactivity disorder (ADHD). The present study with a 4-year-old ADHD boy found attentive calmness was substantially increased from a mean of about 3 seconds per trial to the maximum scheduled duration of 60 seconds by using a scheduled period of physical activity as the reinforcer for the attentive-calmness. These results suggest the possible use of this type of reinforcer as an addition or substitution for the usual reinforcers in contingency management with ADHD children.

Treating Hyperactivity with Dexedrine and Activity Feedback

Using a single-case experimental design, this study evaluated the effects of Dexedrine and an activity feedback and reinforcement procedure on several behavioral components of the hyperactivity syndrome. The results showed that Dexedrine improved classroom on-task behavior and lunchroom gross motor behavior but had no effect on activity level, as measured by a movement monitor worn on the child's wrist. After replicating these effects in a second phase of Dexedrine, an activity feedback and reinforcement procedure was combined with medication to reduce the subject's excessive rate of activity. This procedure involved sequentially adding three components of the activity feedback procedure in order to determine the significance of instructions, guided practice, and activity feedback and reinforcement for reducing activity. Results indicated that activity feedback and reinforcement produced the largest reductions in activity.

Behavioral Compensation

When the consequences of a response become less reinforcing in the presence of one stimulus, reinforced responding in the presence of a second stimulus often increases. This phenomenon is called positive behavioral contrast. This research evaluated the effects of an analogous manipulation in an applied setting within the context of a classroom token economy. Seven severely to profoundly hearing impaired middle school students who were disruptive and low-achieving in math class served as subjects. After a pretoken economy baseline, token reinforcement was instituted at three learning stations. Reinforcement was then withdrawn from two of the three stations but continued at the remaining one. The results indicated that academic response rate increased at the station where reinforcement was continued while it decreased at the two stations where it was withdrawn. These effects were reversed when reinforcement was reinstated at all three stations. The reciprocal relationship between increases in academic performance and decreases in measures of classroom disruption previously reported in the literature was also replicated.

Behavioral Approaches to Childhood Disorders

This article presents a survey of the child behavior therapy literature, drawing upon reviews and outcome studies published in the past five years. A number of criticisms are made. Child behavior therapy research needs to acquire a greater developmental focus, conduct more complex functional analyses, place greater emphasis on assessment and description of subjects, and employ more consistent use of adequate designs and procedures. Recent work, nonetheless, reflects greater methodological and conceptual sophistication than was found in earlier reviews.

Educating the ADHD Child: Debunking the Myths

Recent statistics show that children exhibiting Attention Deficit Hyperactivity Disorder (ADHD) represent a significant number of school-based referrals for psychoeducational assessment and intervention. Despite the pervasiveness and salience of this disorder, educators continue to labor under a number of misconceptions about the nature of ADHD and what constitutes appropriate school-based assessment and intervention practice. In this article, common myths with regard to conceptual issues and assessment and intervention strategies are generated and responded to with practical research-based information.

Attention Deficit-Hyperactivity Disorder

Attention deficit-hyperactivity disorder (ADHD) is a common problem among school-aged children wherein a student exhibits significant difficulties with attention span, impulse control and activity level. Since children with ADHD often display these symptoms on a chronic basis resulting in impaired behavior control and academic productivity, the classroom environment must be modified to enhance their adjustment. Several contingency management procedures for teacher use are briefly discussed in this paper including token reinforcement programs, contingency contracting, response cost, time-out from positive reinforcement and home-based contingency management programs. When used in conjunction with other treatment modalities (e.g. stimulant medication, parent training in behavior modification), these classroom intervention strategies often lead to significant improvements in on-task behavior, work completion, behavioral control and accuracy on academic assignments.

Some guidelines for conducting research in applied behavioral pharmacology

The Journal of Applied Behavior Analysis (JABA) has published a number of articles on the behavioral effects of psychomotor stimulant drugs in individuals with attention deficit hyperactivity disorder. Some additional JABA publications have included investigations of the behavioral effects of other drugs. However, a review of these articles revealed many methodological differences among studies, which makes it difficult to evaluate the relative contribution of each research effort to the overall database. In this context, we offer some guidelines to solidify the methodological rigor of behavior pharmacological research published in JABA.

Matching theory in natural human environments

Matching theory is a mathematical account of behavior, many aspects of which have been confirmed in laboratory experiments with nonhuman and human subjects. The theory asserts that behavior is distributed across concurrently available response alternatives in the same proportion that reinforcement is distributed across those alternatives. The theory also asserts that behavior on a single response alternative is a function not only of reinforcement contingent on that behavior, but also of reinforcement contingent on other behaviors and of reinforcement delivered independently of behavior. These assertions constitute important advances in our understanding of the effects of reinforcement on behavior. Evidence from the applied literature suggests that matching theory holds not only in laboratory environments, but also in natural human environments. In addition, the theory has important therapeutic implications. For example, it suggests four new intervention strategies, and it can be used to improve treatment planning and management. Research on matching theory illustrates the progression from laboratory experimentation with nonhuman subjects to therapeutic applications in natural human environments.

Making Behavioral Activation More Behavioral

Behavioral Activation, an efficacious treatment for depression, presents a behavioral theory of depression—emphasizing the need for clients to contact positive reinforcement—and a set of therapeutic techniques—emphasizing provision of instructions rather than therapeutic provision of reinforcement. An integration of Behavioral Activation with another behavioral treatment, Functional Analytic Psychotherapy, addresses this mismatch. Functional Analytic Psychotherapy provides a process for the therapeutic provision of immediate and natural reinforcement. This article presents this integration and offers theoretical and practical therapist guidelines on its application. Although the integration is largely theoretical, empirical data are presented in its support when available. The article ends with a discussion of future research directions.

A modern behavioral perspective on child conduct disorder: integrating behavioral momentum and matching theory

It has been suggested that knowledge produced within the operant laboratory is of little or no use to clinicians. I argue, on the contrary, that laboratory science has provided clinicians with two general principles that may expand the focus of behavioral family therapy to incorporate a wide range of clinical interventions that have heretofore been considered nonbehavioral. These principles, matching theory and behavioral momentum, outline the relativity of reinforcement and the persistence of behavior in the absence of reinforcement, respectively. These principles make specific predictions concerning clinical interventions aimed not only at identified reinforcement contingencies, but also the context within which reinforcement contingencies are operative. This expanded behavioral formulation allows both the clinician and the researcher a framework for designing, implementing, and assessing techniques that target cognition, affect, and interpersonal relationships, as well as specific behaviors.

The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: a 9-month follow-up

Using a double-blind, placebo design, we evaluated 96 attention-deficit hyperactivity disordered children for the effects of methylphenidate alone and in combination with behavioral parent training plus child self-control instruction. Seventy one of the children completed the treatment protocol. As reported previously, main effects were found for medication at posttest; however, there was no evidence of additive effects. Nine months after the termination of the behavioral interventions and the withdrawal of the stimulant medication, we found limited support for the hypothesis that the combined conditions would produce greater maintenance of treatment gains than would medication alone.

Behavioral treatment of attention-deficit hyperactivity disorder in the classroom. The use of the attention training system

Contingency management procedures have been successfully applied in a variety of school settings to treat children with Attention-Deficit Hyperactivity Disorder (ADHD). The present study investigated the efficacy of response-cost contingencies alone and in combination with directed-rehearsal procedures for managing the classroom behavior and academic productivity of two boys with ADHD. A within-subject reversal design with multiple-baseline components across academic work periods (i.e., reading and language) was employed to evaluate each child's behavior and academic performance. Response-cost contingencies led to marked improvements in each student's task-related attention and a reduction in other ADHD symptoms. Response-cost effects on academic productivity and differential effects associated with directed-rehearsal contingencies were equivocal. In addition to promoting greater attention to independent seat-work, response-cost procedures have the potential to affect other important areas of classroom functioning such as behavioral control during teacher lectures.

Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder

Twenty-four boys with attention deficit-hyperactivity disorder (ADHD) participating in an intensive summer treatment program each received b.i.d. placebo and two doses of methylphenidate (MPH, 0.3 mg/kg and 0.6 mg/kg) crossed with two classroom settings: a behavior modification classroom including a token economy system, time out and daily home report card, and a "regular" classroom setting not using these procedures. Dependent variables included classroom observations of on-task and disruptive behavior, academic work completion and accuracy, and daily self-ratings of performance. Both MPH and behavior modification alone significantly improved children's classroom behavior, but only MPH improved children's academic productivity and accuracy. Singly, behavior therapy and 0.3 mg/kg PMH produced roughly equivalent improvements in classroom behavior. Further, the combination of behavior therapy and 0.3 mg/kg MPH resulted in maximal behavioral improvements, which were nearly identical to those obtained with 0.6 mg/kg MPH alone.

Relative efficacy of ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.

The effects of behavioral parent training on families with young hyperactive children

We sought to assess, through two case-studies, the strengths and limitations of a time-limited, family-based behavioral intervention for preschool-aged children with attention-deficit-hyperactivity disorder (ADHD). The families completed a ten week child management training program and attended a number of follow-up sessions. Changes in parent and child functioning were assessed with a variety of rating scales, interviews, and data collected by parents at home on targeted behavior problems. Improvements were found in parents' confidence in their child management ability and knowledge of behavioral principles, in certain child behavior problems, in parental ratings of hyperactivity, and in the parent-child relationship. Implications of the findings for the treatment of young children with hyperactivity are discussed.

Psychophysiological effects of methylphenidate (Ritalin)

The nature and psychophysiological effects of methylphenidate whose metabolism, pharmacokinetics, and effects on human behavior are not well known are the focus of this review. Methylphenidate treatment of attention deficit disorder with hyperactivity is presented summarily.

Hypnotherapy: a possible alternative for treating pupils affected with attention deficit disorder

The purpose of this study was to ascertain the effectiveness of hypnotherapy in treating attention-deficit-hyperactivity by certified psychologist and physicians. The 7 boys and 4 girls were enrolled in a Special Day classroom for hyperkinesis and behavior problems and were being given methylphenidate (Ritalin). Three attempts were made to hypnotize these subjects; however, the group had to be reduced from 11 to 3 and finally, from 3 to a single child to be successful. A significant improvement from pre- and post-hypnotic sessions was noted.

Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom

Sixteen children meeting diagnostic criteria for Attention Deficit Disorder with Hyperactivity (ADD-H) were tested on methylphenidate (0.3 mg/kg) and placebo on cognitive, learning, academic and behavioral measures in a double-blind study. Assessments were carried out in the laboratory and in the children's regular classrooms. Results indicate methylphenidate-induced improvements on a majority of the measures. Drug-induced changes reflected increased output, accuracy and efficiency and improved learning acquisition. There was also evidence of increased effort and self-correcting behaviours. It is argued that reviewers have underestimated the potential of stimulants to improve the performance of ADD-H children on academic, learning and cognitive tasks.

Quantitative criteria for attention and activity in child psychiatric patients

The aim was to find empirically justified criteria for attention and activity. Patients with various disorders and controls were observed during psychiatric examinations. Measures of attention increased with age, were lower in patients than controls, were correlated with each other and related to the quality of task performance. Activity measures decreased with age, were higher in patients, were correlated among each other and concerned motility as well as talking initiatives. Criteria from other studies and the DSM-III were critically examined. Inattention was not associated with hyperactivity, except in mentally retarded children. Inattention was common in many diagnostic categories.

Rate-dependency and hyperactivity: methylphenidate effects on operant responding

The two most common treatment for hyperactivity are psychopharmacological regimens and behavior therapy. Although the concurrent use of stimulant medication has been purported to enhance a child's rate of responding under a behavior management program, studies examining the interaction of the two treatments have been unable to confirm this hypothesis. The present investigation sought to examine the effects of differing levels of methylphenidate hydrochloride (Ritalin) upon operant responding with hyperactive children. After an initial drug-free training period, 10 first through fourth grade hyperactive males performed an operant key-pressing task under a mult VR 5 FI 30 sec reinforcement schedule across four randomly determined, double-blind drug conditions (placebo, 5, 10, 15 mg). Only VR responding changed significantly during medication conditions; however, rate-dependent psychostimulant effects were found within both reinforcement schedules. Discrepancies with animal rate-dependency and implications for treatment and future research are discussed. Medication effects on operant responding appear to depend upon the reinforcement schedule and dose employed.