Unit 9 Flashcards
Behavioral Pediatrics in Primary Care
-the application of behavioral analysis and developmental psychology to child behavioral problems presenting in primary care settings
Behavioral Pediatrics in Primary Care-Major Emphasis
-prevention over cure/rehab
Two Types of Intervention in Bxal Pediatrics
- Supportive Health Education
2. Prescriptive Treatment
Three Domains of Care in Bxa’ Pediatrics
- Common Behavior Problems
- Behavior problems with significant medical (biological) dimensions
- Medical (biological) problems with significant behavioral dimensions
Definition of Prescriptive Treatment
-when we provide tx for bx already occuring
Common Bx Problems Presenting in Primary Care
- high frequency/low intensity problems
- responsive to prescriptive bxal treatments
- approx. 50% of all primary care child visits involve behavior problems
Common behavior problems are not pathologies…
they are skill deficits (parents are ‘on their own’)
Common parenting tactics for pediatric behavior problems..
-ignoring, warning, yelling, spanking, rewarding, reasoning, placating, or indulging
What is the rule of thirds?
1/3 of pediatric bxal problems get better
1/3 get worse (our population)
1/3 manage
Skinner’s vision for behavior analysis…
has yet to be fully realized
What is the major emphasis in behavioral pediatrics?
-prevention
What are the two types of intervention in behavioral pediatrics?
- (supportive) health education
- prescriptive treatment
Dr Friman supplied a list of the top behavior problems in 3 year old children and then argued that parents were pretty much on their own when solving them. Why?
the problems are not pathologies in 3 yos
Info on the gap in Behavioral Health Care for Children:
- primary care pediatrics on one side
- conventional mental health services for children on the other
- vast range of behavioral health problems in the gap
Why might pediatricians not address common behavior problems?
- limited or no time
- limited or no training
- lack of inclination
Why are parents reluctant to seek mental health services for children?
- Over-interpretation in practice:
a. underlying problem syndrome
b. Berkson’s bias: emphasis on highly impaired populations
c. Textbook case bias: emphasis on extreme cases - Research Practices: Correlative theory building over intervention
- Public Impressions: not flattering
- highly variable quality in mental health services
Common behavior problems in three year olds are typically the result of:
skill deficits
Sample Health Education topics in Behavioral Pediatrics in primary care:
- learning
- crying
- sleep
- toilet readiness
Children learn through repetition with
contrast in experience
2 types of change in Clarifying Contrast
- Quality
2. Quantity
Quality of Clarifying Contrast
- determines direction of learning
1. Pleasant
a. reward (positive reinforcement)
b. relief (negative reinforcement)
2. Unpleasant
a. pain (positive punishment)
b. loss (negative punishment)
Quantity of Clarifying Contrast
- determines need for repetition
1. Large-large change, less repetition
2. Small-small change, more repetition
This determines direction of learning
quality of the consequence
This determines the need for repetition
quantity of the consequence
Crying is ..
the number one cause of child abuse. Provide health education-crying is normal.
Toileting Readiness
- Physical readiness: raise and lower pants, pincer grasp, fully ambulatory, sit independently
- Bladder readiness: dry for several hours
- Language readiness: toileting words
- Instructional readiness: follow simple instructions
- Proprioceptive readiness: awareness of urge
- Emotional-social readiness: assess for clinical significance
According to Dr. Friman, typically developing infants:
cry an average of 2-3 hours a day in the first 4-8 weeks of life
Dr Friman described a toilet training program called “drink up-undress-play and pay”. In that program “drink up” refers to?
increased fluid loading to increase learning trials
The best descriptor for the “pay” step in Dr Friman’s “drink up-undress-play and pay” toilet training program is?
contingent rewards
What variable determines the amount of repetition needed for child learning?
the size of the contrast or experiential change
Sample Toddler Misbehavior Targets
- toddler misbehavior
- bedtime problems
- simple habits
- defiance, non-compliance, and rule infractions in older children
- simple phobia
How/why ABA can help Toddler Misbehavior?
- danger seeking
- systematic use of carrot and stick
- repetition
- Strategic use of nothing (time in/time out)
How to effectively treat bedtime resistance?
- escape extinction (ignoring)
- often avoided by caregivers because of the extinction burst
What might be a target behavior for an active one year old infant?
dangerous behavior (they are ‘testing’ their env’t)
What might be an appropriate location for time out used with a one year old infant?
playpen
What is the best method for treating toddler misbehavior?
time in and time out
What is the most crucial variable for establishing effective time out?
time in
What is the most effective method for treating bedtime resistance?
escape extinction
Despite its effectiveness, most parents are reluctant to use escape extinction to treat bedtime resistance. What is the most likely reason for this?
extinction burst
What are the likely active ingredients in the bedtime pass program?
- escape extinction
- DRA
When to use Taste Treatment for Thumb Sucking
- when older than 5 yo
- in more than one env’t
- other problems such as physical damage, buck teeth, check with pediatrician
Taste Treatment for Thumb Sucking
- non-punitive procedure (reminding rather than punishing, “reminder fluid” taste treatment)
- child involvement (done with, not to, child)
- systematic application
- fading procedure
Job-Based Grounding
- menial jobs are assigned when child engages in misbehavior (make sure they are not super important so as to not impact the family flow)
- grounding is done when the job(s) are completed (instead of duration of time)
- parents need to not nag, not remind about jobs to be done, not re-hash why being punished
in the aversive taste treatment of thumb sucking the aversive taste is characterized as
reminder fluid
Job based grounding is superior to tie based grounding because
- release from job-based grounding is based on appropriate behavior whereas release from time-based grounding is based on passage of time
- time-based grounding can function as an establishing operation for inappropriate behavior
In the job-based grounding treatment described by Dr Friman, he encourages parents to
explain why grounding occurred and the rules once/twice clearly and then quietly monitor child progress
With anxiety/phobia concerns, there is another bx impacted
track that permanent product (such as math calculations)
Define respondents and operants
Respondents: controlled by antecedent stimuli
Operants: controlled by both antecedents and consequences
Why is spermatogenesis relevant to behavior analysis?
- sperm are organisms that behave
- their behavior occurs in an environment
- that environment exerts strong influence on sperm behavior
- that environment is changeable
Dr Friman discusses early work on anxiety by Estes and Skinner. In their study, they characterized anxiety as:
conditioned suppression
Dr. Friman discussed the most effective treatment for anxiety currently available it is
-exposure and response prevention
One of the best known and most widely used treatments in clinical psychology is called Exposure and Response Prevention. A behavior analytic synonym for it is:
escape extinction
Dr Friman’s study on male fertility attracted a large amount of media attention. His explanation for why this was the case was?
because the subject of the study is a mainstream concern
What is a hallmark of behavior analysis contributed the most to Dr. Friman’s study on male fertility?
single subject research methods
The environmental variable that Dr. Friman manipulated in his study of ashtray usage was?
distance from door into hospital to ashtray
The specific dependent measure that Dr. Friman used in his study of ashtray usage was?
cigarette butts in ashtrays
According to Dr Friman what is the best variable to manipulate in order to reduce littering?
effort
Which of the following mainstream topics did Dr. Friman recommend for behavior analytic study?
anxiety and depression
