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Biomedical subjects

Frank J Symons

Publications and source records attributed to Frank J Symons.

15 recordsLinked to original sources
PubMed2006

Matching analysis of socially appropriate and destructive behavior in developmental disabilities.

This study examined socially appropriate and destructive behavior in unconstrained natural environments using a matching law analysis (MLA) of real time observational data. The participants were two school-age children and one adult with mild to moderate cognitive disabilities. Event lagged sequential analysis (SQA) provided the obtained rates of staff attention to socially appropriate and inappropriate behaviors, which were then used in the matching law equations. For one participant the matching analysis showed a high (72%) variance-accounted-for (VAF) in behavior allocation in response to attention. For a second participant, matching analysis conducted on behavior allocation in response to staff attention showed lower (50%) VAF by staff attention. In the third case, the MLA also showed high (94%) VAF by attention. Suggestions for future extensions of matching analysis to clinically significant behavior and the limitations of the MLA for evaluating functional relationships in natural environments are discussed.

Adolescent↗
PubMed2006

Parent evaluation of spasticity treatment in cerebral palsy using botulinum toxin type A.

OBJECTIVE: To assess parent ratings of treatment acceptability associated with botulinum toxin type A (BTX-A) injection for spasticity in children with cerebral palsy (CP). DESIGN: A single-point survey design across a sequentially recruited cohort, using a standardized evaluation measure. SETTING: Regional specialty health care center medical clinic and pain research program. PARTICIPANTS: Fifty-nine parents of children with CP receiving BTX-A injection for spasticity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Treatment Evaluation Inventory. RESULTS: Overall, parent ratings of treatment acceptability ranged from moderate to high. There were no significant differences for caregiver ratings in relation to characteristics of the raters (age, sex, marital status) or of the children (age, sex, mental retardation, severity of disability) characteristics. CONCLUSIONS: These findings indicate that on average, parents of children with CP consider BTX-A treatment for the management of spasticity to be an acceptable form of treatment.

Adolescent↗
PubMed2006

Comparing observational software with paper and pencil for time-sampled data: a field test of Interval Manager (INTMAN).

In this article, we describe the Interval Manager (INTMAN) software system for collecting time-sampled observational data and present a preliminary application comparing the program with a traditional paper-and-pencil method. INTMAN is a computer-assisted alternative to traditional paper-and-pencil methods for collecting fixed interval time-sampled observational data. The INTMAN data collection software runs on Pocket PC handheld computers and includes a desktop application for Microsoft Windows that is used for data analysis. Standard analysis options include modified frequencies, percent of intervals, conditional probabilities, and kappa agreement matrices and values. INTMAN and a standardized paper-and-pencil method were compared under identical conditions on five dimensions: setup time, duration of data entry, duration of interobserver agreement calculations, accuracy, and cost. Overall, the computer-assisted program was a more efficient and accurate data collection system for time-sampled data than the traditional method.

Behavioral Research↗
PubMed2005

A prospective clinical analysis of pain behavior and self-injurious behavior.

It is a widely assumed but rarely tested proposition that the experience and expression of pain is altered among individuals with self-injurious behavior and disabilities. As a preliminary test of this proposition, the purpose of this case study was to apply a validated pain measure to examine ratings of pain behavior in relation to ratings of self-injurious behavior (SIB). A prospective correlational design was used with maternal ratings completed three times/day for 9 days using two item independent rating scales specific to pain and SIB. The participant was a 6-year-old boy with severe SIB secondary to midbrain tumor (pilocytic astrocytoma) resection and post-operative sequelae. Measures were taken in the child's home. Pain behavior was measured using the Non-Communicating Children's Pain Checklist Revised (NCCPC-R). Self-injury was measured using the Self-Injury Trauma Scale (SITS). Time intervals associated with elevated ratings of SIB were associated with elevated pain ratings. There was a significant difference (P<0.05) for pain ratings between time intervals with and without self-injury. It is suggested that additional empirical work is needed to clarify the relation between pain and self-injury to improve assessment and treatment outcomes.

Child↗
PubMed2004

Self-injurious behavior and the efficacy of naltrexone treatment: a quantitative synthesis.

People with mental retardation, autism, and related developmental disabilities who self-injure are treated with a wide array of behavioral techniques and psychotropic medications. Despite numerous reports documenting short-term and some long-term changes in self-injury associated with the opiate antagonist naltrexone hydrochloride, no quantitative review of its efficacy has been reported. We conducted a quantitative synthesis of the peer-reviewed published literature from 1983 to 2003 documenting the use of naltrexone for the treatment of self-injurious behavior (SIB). Individual-level results were analyzed given subject and study characteristics. A sample of 27 research articles involving 86 subjects with self-injury was reviewed. Eighty percent of subjects were reported to improve relative to baseline (i.e., SIB reduced) during naltrexone administration and 47% of subjects SIB was reduced by 50% or greater. In studies reporting dose levels in milligrams, males were more likely than females to respond. No significant relations were found between treatment outcomes and autism status or form of self-injury. Results are discussed with respect to future efficacy work related to study outcomes and the pharmacological treatment of self-injury.

Adolescent↗
PubMed2004

Obtained versus programmed reinforcement practical considerations in the treatment of escape-reinforced aggression.

This investigation provides a preliminary examination of the difference between programmed and obtained reinforcement rates and its potential influence during treatment of aggression in a natural setting. Following a functional analysis that suggested that the aggression of a boy with autism was negatively reinforced, intervention was implemented by the boy's mother. Concurrent fixed-ratio (FR) 1 FR 1 schedules of escape were arranged for manding and aggression. When mands failed to compete effectively with aggression, obtained reinforcement ratios were calculated; these indicated that obtained reinforcement varied from the programmed schedule for aggression but not for mands. Increasing the rate of prompts for mands resulted in an increase in mands and a decrease in aggression to near-zero levels.

Aggression↗
PubMed2003

Self-injurious behavior in young boys with fragile X syndrome.

In this study, we distributed surveys to 67 families of young boys with fragile X syndrome to determine the prevalence, onset, form, function, location, and correlates of self-injurious behavior. Fifty-five surveys were completed (82%). The mean age of the boys at the time of the survey was 80 months (range = 20-144). Self-injurious behavior (SIB) was reported for 58% of the participants with a mean age of onset of 31 months. The mean number of forms of self-injury was 2 per participant. Biting was the most commonly reported form of self-injury with the fingers and back of the hand disproportionately targeted as the most prevalent self-injury body site. There was no linear increase in risk of SIB with age past 25 months. SIB was reported as most likely to occur following the presentation of difficult task demands or changes in routine. Significant group differences were found between overall ratings of problem behavior for boys with self-injury compared to those without self-injury. Groups did not differ on measures of fragile X mental retardation protein (FMRP), autism status, adaptive behavior, or age first medicated. Results are discussed in terms of future research designed to further elucidate the behavioral phenotype of fragile X syndrome.

Age Factors↗
PubMed2003

Maternal judgments of intentionality in young children with autism: the effects of diagnostic information and stereotyped behavior.

This study examined the relation among maternal judgment of intentionality and variables relevant to families of children with autism. Thirty-six mothers of children with autism rated segments of home videotape of behavior from very young children later diagnosed with autism. Mothers were randomly assigned to either a diagnostic or a no diagnostic information group. No significant difference was found on overall ratings of intentionality. Maternal stress was not correlated with overall ratings of intentionality for either group. Mothers in the diagnostic information group rated stereotyped behavior as less intentional. Post hoc analyses showed no differences on maternal ratings of intentionality when the child was in a social setting or interacting with an object, but there were significant differences between ratings when the child was alone. The results are discussed in relation to early development and identification issues in autism.

Adult↗
PubMed2003

Relation between pain and self-injurious behavior in nonverbal children with severe cognitive impairments.

OBJECTIVES: To explore whether self-injurious behavior (SIB) alters pain expression in children with severe cognitive impairments and the relation between SIB and chronic pain. STUDY DESIGN: Caregivers of 101 nonverbal children 3 to 18 years of age (55% boys) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R) retrospectively and for an observed pain episode. Caregivers of children with SIB (n = 44) completed the Behavior Problems Inventory, the Self-Injury Grid, and the Self-Injury and Self-Restraint Checklist. RESULTS: Multivariate analysis of variance indicated that NCCPC-R scores did not differ between children with and those without SIB. However, t tests indicated that children with chronic pain (n = 13) self-injured less body surface (P =.01) and fewer body sites (P =.04) than did children without (n = 31). Multiple Correspondence Analysis generated 2 dimensions (49% variance), suggesting a distinction between two SIB forms: (1) high frequency of SIB to the head/hand and absence of chronic pain and (2) less frequent SIB near the site of pain. CONCLUSIONS: Children with severe cognitive impairments who display SIB do not have reduced pain expression, and chronic pain may influence the frequency and location of SIB. Further research should examine the usefulness of these findings for management of SIB and pain.

Adolescent↗
PubMed2003

Single-case experimental designs: applications in developmental-behavioral pediatrics.

This article discusses single-case experimental designs (SCEDs) and their relevance to developmental-behavioral pediatrics. Information concerning SCEDs have not been described in the Journal of Developmental and Behavioral Pediatrics, despite its relevance to the field. General issues related to the underlying logic and applications of SCEDs are reviewed with examples selected from the literature to illustrate the strengths and weaknesses of different design strategies. It is suggested that SCEDs can be a useful alternative to traditional between-group designs for clinical and evaluation research because the unit of the analysis is the individual; therefore the feedback to clinicians and families is direct about the effectiveness of a behavioral intervention or medication for that individual. In the field of developmental-behavioral pediatrics, SCEDs can be especially useful in the management of vague symptoms or poorly defined diseases to improve the confidence in a treatment decision for an individual patient. This report is intended to facilitate the understanding and use of single-case methodology so that clinicians are aware that flexible, true experiential designs exist to fill the gap in knowledge and also "do the best for my patient."

Behavior Therapy↗
PubMed2003

Altered diurnal pattern of salivary substance P in adults with developmental disabilities and chronic self-injury.

Morning and afternoon salivary substance P and cortisol levels were measured in 26 adults with chronic self-injurious behavior (SIB) and severe developmental disabilities and compared with matched controls without SIB. Chronic SIB was associated with an altered diurnal pattern of salivary substance P relative to matched controls, characterized primarily by lower levels of morning substance P, which were significantly correlated with overall severity of SIB. There was a trend for SIB subjects to exhibit higher levels of cortisol, which was significantly correlated with overall severity of SIB. These results support a model of altered nociception and possible stress-induced analgesia among individuals with developmental disability and chronic SIB.

Adult↗
PubMed2003

Sequential and matching analyses of self-injurious behavior a case of overmatching in the natural environment.

In this study, we examined the relation between naturally occurring rates of self-injurious behavior and appropriate communicative behavior using prospective sequential and matching analyses of descriptive data. Results from both analyses suggested reliable covariation between both forms of behavior and staff attention. Findings are discussed in terms of the applicability of quantitative descriptive analyses to characterize behavior-environment relations in natural contexts.

Activities of Daily Living↗