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Biomedical subjects

M F Cataldo

Publications and source records attributed to M F Cataldo.

At least 19 recordsLinked to original sources
PubMed2001

Self-injurious behavior: gene-brain-behavior relationships.

This paper summarizes a conference held at the National Institute of Child Health and Human Development on December 6-7, 1999, on self-injurious behavior [SIB] in developmental disabilities. Twenty-six of the top researchers in the U.S. from this field representing 13 different disciplines discussed environmental mechanisms, epidemiology, behavioral and pharmacological intervention strategies, neurochemical substrates, genetic syndromes in which SIB is a prominent behavioral phenotype, neurobiological and neurodevelopmental factors affecting SIB in humans as well as a variety of animal models of SIB. Findings over the last decade, especially new discoveries since 1995, were emphasized. SIB is a rapidly growing area of scientific interest to both basic and applied researchers. In many respects it is a model for the study of gene-brain-behavior relationships in developmental disabilities.

Animals↗
PubMed1994

Behavioral assessment and treatment of pediatric feeding disorders.

Pediatric feeding disorders are estimated to occur in as many as one in every four infants and children, and when serious can require numerous, costly and sustained interventions. For over a decade research has cumulated evidence on the contributions of Behavior Analysis in understanding and remediating some types of pediatric feeding disorders. The systematic use of this body of evidence in conjunction with other approaches (medical, nutrition, occupational therapy, physical therapy, and so forth) is being carried out on an inpatient treatment unit at the Kennedy Krieger Institute. Key aspects are described here, including direct observation behavior assessment, approaches for increasing and decreasing feeding behavior, skill acquisition, transfer of treatment gains, and parent training. The results based on case studies and overall program evaluation indicate that medically complicated, severe feeding disorders can be treated successfully in a few months with a multidisciplinary approach which incorporates behavioral procedures.

Adolescent↗
PubMed1993

Behavior analysis and intervention during hospitalization for brain trauma rehabilitation.

Continued problematic behavior in children and adolescents after brain trauma is a major barrier to medical care, rehabilitation, and eventual independent living. The present study demonstrates the application of already well-developed behavior analysis techniques to the early posttrauma expression of behavior problems during hospital recovery. To satisfy concerns regarding both cost and individualized treatment, interventions were carried out primarily by regular hospital staff (nurses and therapists), medical record data were used to document gains, and time series, within subject designs were used to show experimental control. Four patients (three male and one female) ranging in age from 10 to 16 years, received intervention based on behavior analysis techniques, which reduced disruption and increased cooperation with therapy and medical care. Behavior analysis techniques will be relevant to future rehabilitation research to the extent that the posttrauma patient's behavior is effected by environmental consequences as demonstrated here.

Adolescent↗
PubMed1993

Determinants of children's health care use: an investigation of psychosocial factors.

Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children's depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children's health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children's health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.

Adult↗
PubMed1993

Effects of signaling invasive procedures on a hospitalized infant's affective behaviors.

We report the effects of using a visual and auditory stimulus signaling impending painful medical procedures versus "safe" periods on the affective behavior of a hospitalized infant. The results of a reversal design suggested that the signaling procedures increased positive behaviors and decreased negative behaviors during both noninvasive and invasive caregiver events.

Adaptation, Psychological↗
PubMed1993

Behavior analysis of motion control for pediatric neuroimaging.

Magnetic resonance imaging is a promising technological advance used for research and diagnosis of disease. The procedure has no risks, except when uncooperative patients require sedation. Four normal children participated in simulated scans to study the effects of (a) antecedent changes in the imaging environment and (b) operant conditioning of movement inhibition. Changing the environment can decrease movement, but operant contingencies were necessary to decrease movement to a level that, in most cases, would allow the procedure to occur without sedation.

Behavior Therapy↗
PubMed1992

Behavior of injured and uninjured children and their parents in a simulated hazardous setting.

Compared the behavior of parents and their previously injured children with parents and their uninjured children in unstructured play and distracted parent conditions. Injured children were more disruptive, more active, and had more contacts with hazards, whereas uninjured children had more appropriate behavior. Parents of injured children had lower rates of play activities. Observable classes of parent and child behaviors amenable to change were associated with a history of child injury. Further study is needed to assess the use of safe and unsafe behavior as proxy measures for injuries and to identify functional classes of safe and unsafe behavior for which active strategies can be developed to prevent children's injuries.

Accident Proneness↗
PubMed1992

Health consequences of behaviors: injury as a model.

Injury is the third leading cause of death in the United States and the leading cause for children, adolescents, and young adults. Injury results from multiple factors and so may its prevention. The first and simplest approach toward preventing injuries has been to innovatively and aggressively apply a traditional public health model. Strategically, the goal has been to remove harmful agents of injury and to make the environment safer. Tactics such as public information, product regulation, legislative action, and the like have been credited with reductions in mortality and morbidity. To expand our understanding and our prevention strategies across multiple injuries, other scientific knowledge bases and intervention models from fields such as psychology and child development are being used to study childhood injury. These approaches show that in addition to environmental determinants, psychosocial factors involving both the care giver and the child are related to injury. The research programs described here illustrate the advantage of investigating psychosocial factors at both molar and molecular levels. General characteristics of mothers and children related to injury help define families at risk, as well as suggesting vehicles for intervention. Behavioral factors influencing risk perception highlight the etiology of increased risk in adolescence. Injury episodes, even slight, as well as "near injuries" and dangerous and risky behavior can be quantified and analyzed by retrospective ("postmortem") approaches yielding data on commonly occurring consequences (and the lack thereof) for minor injury. Finally, approaches that simulate dangerous situations can identify interaction patterns that result in childhood injury. Based on such research, we are coming to view injuries as the result of patterns of behaviors that develop and persist over time, and as such these patterns can be detected and, one hopes, altered before a serious medical event occurs. The role of the pediatrician after injury occurs is clear. With regard to prevention of injuries, pediatricians' roles are being defined by those individuals who have begun to investigate causes, educate families, and advocate for regulation and prevention. However, like the causes and methods for prevention, the disciplines involved in the study and prevention of injury are multiple. Such a multidisciplinary approach that considers multiple factors, theories, models, and interventions to prevent injury may be the approach that is as simple as possible.

Adolescent↗
PubMed1991

Psychology in primary health care: effects of brief targeted therapy on children's medical care utilization.

Evaluated the impact of psychological treatment for 93 children (ages 1-15) with common behavior, toilet, school, and psychosomatic problems. Children and parents, who were members of a health maintenance organization, had 1-6 visits to a primary care-based psychological consultation service. Individualized treatment was guided by problem-specific behavioral protocols. Parent outcome and behavior checklist ratings indicated improvement or resolution for 74% of children and high satisfaction with the psychological service. Children's use of medical services, especially acute primary care visits, was reduced during the year after treatment; a matched comparison group's use was unchanged. Addressing children's unmet mental health needs reduces medical care utilization. A primary health care model of psychological services provides an integrated system for serving the health and mental health needs of children.

Adolescent↗
PubMed1990

Pediatric appointment keeping: improving adherence in a primary care allergy clinic.

We evaluated the effects of introducing and discontinuing an intervention designed to improve adherence with scheduled appointments in a pediatric allergy clinic. Five nonadherent and three adherent patients received reminders and incentives for keeping their scheduled appointments. Adherence with appointments increased for three of the five nonadherent children, who had an average increase of 13%, and adherent patients continued to keep appointments during the intervention condition. After 10 scheduled allergy clinic appointments had been kept, incentives were discontinued while reminders continued. Improvements in adherence were not maintained after incentives were discontinued and two children showed reductions in adherence to below-baseline levels. Incentive programs increase appointment keeping, but discontinuing incentives abruptly may result in the return of nonadherence, even when reminders are provided as a maintenance strategy. Future pediatric psychology research and practice should investigate both the benefits and limitations of strategies designed to improve adherence.

Adolescent↗
PubMed1990

Experimental analysis and extinction of self-injurious escape behavior.

Three studies are presented in which environmental correlates of self-injurious behavior were systematically examined and later used as the basis for treatment. In Study 1, 7 developmentally disabled subjects were exposed to a series of conditions designed to identify factors that maintain self-injurious behavior: attention contingent on self-injurious behavior (positive reinforcement), escape from or avoidance of demands contingent on self-injurious behaviour (negative reinforcement), alone (automatic reinforcement), and play (control). Results of a multielement design showed that each subject's self-injurious behavior occurred more frequently in the demand condition, suggesting that the behavior served an avoidance or escape function. Six of the 7 subjects participated in Study 2. During educational sessions, "escape extinction" was applied as treatment for their self-injurious behavior in a multiple baseline across subjects design. Results showed noticeable reduction or elimination of self-injurious behavior for each subject and an increase in compliance with instructions in all subjects for whom compliance data were taken. The 7th subject, whose self-injurious behavior during Study 1 occurred in response to medical demands (i.e., physical examinations), participated in Study 3. Treatment was comprised of extinction, as in Study 2, plus reinforcement for tolerance of the examination procedure, and was evaluated in a multiple baseline across settings design. Results showed that the treatment was successful in eliminating self-injurious behavior and that its effects transferred across eight new therapists and three physicians. General implications for the design, interpretation, and uses of assessment studies are discussed.

Adolescent↗
PubMed1990

Children with self-injurious behavior.

Self-injurious behavior is a serious problem that is not uncommon among individuals with mental retardation. Medical and developmental characteristics of 97 children, adolescents, and young adults (age range 11 months to 21 years, 11 months) assessed and treated for self-injurious behavior in a specialized, interdisciplinary inpatient unit between 1980 and 1988 were reviewed. This population differed from those reported in previous studies in that it was of school age and predominantly community based. Severe or profound mental retardation was present in 82.5% of our patients. The causative diagnoses associated with self-injurious behavior were similar to those of severe mental retardation alone. Associated disabilities represented at greater than expected frequencies included pervasive developmental disorders, visual impairment, and a history of infantile spasms. Most patients (81.4%) engaged in more than one type of self-injurious behavior. The most common topographies were head banging, biting, head hitting, body hitting, and scratching. Physical injury was documented in 77% of cases; the injuries most frequently reported were excoriations, scars/callus formation, hematomas, and local infection. As community placement of handicapped individuals continues to increase, pediatricians will be called upon to monitor patients who engage in self-injurious behavior.

Adolescent↗
PubMed1987

Psychologic and behavioral effects of antiepileptic drugs in children: a double-blind comparison between phenobarbital and valproic acid.

Traditional clinical monitoring of children with epilepsy does not appear to be sufficiently sensitive to cognitive functioning and behavioral problems. Although subtle, these changes may alter a child's ability to perform well in school and in society. Physicians must prevent seizures without producing intolerable side effects, and ways of more appropriately assessing these side effects must be developed. In this double-blind, counter-balanced, crossover study of 21 children, the effects of phenobarbital and valproic acid on cognitive functioning and behavior were measured. There was no difference in seizure control between the drugs, and each medication was maintained in the therapeutic range for 6 months (mean phenobarbital level, 21.2 micrograms/mL; mean valproic acid level, 94.1 micrograms/mL). Children were treated with each drug for 6 months. Differences between the drugs were seen on measurements of cognitive function and behavior. On four tests of neuropsychologic function, children performed significantly less well while receiving phenobarbital (P less than .01). There was no evidence that the patients were sedated or less able to perform continuous performance tasks while receiving phenobarbital. Parental assessment of behavior indicated significantly worse behavior with the phenobarbital regimen for three items (P less than .01) and children were measurably more "hyperactive" (P less than .05). Routine clinical assessment of the patients did not reveal differences between the drugs with respect to routine laboratory measurements or side effects as assessed by history or physical examination. Although children may appear to tolerate a medication without clinically apparent problems, subtle but significant changes in intellectual function and behavior may be occurring. Additional, more sensitive, methods of monitoring patients while receiving these drugs is necessary.

Adolescent↗
PubMed1986

Experimental analysis of response covariation among compliant and inappropriate behaviors.

Reliable changes in a variety of behaviors, or classes of behaviors, when only one is manipulated experimentally, have demonstrated that even topographically dissimilar responses can be functionally related. We investigated such a relationship between topographically different child behaviors (compliance and inappropriate activities) by using a methodology that tests for response covariation. Five conditions were provided to sequentially increase and decrease first one and then the other of these behaviors, with the degree of covariation between the two behaviors (i.e., the relationship between changes in the targeted and nontargeted behaviors) being the finding of interest. Results showed that, regardless of the intervention used, the behavior targeted, or the direction manipulated, the nontargeted behavior reliably covaried inversely with the targeted one. The findings have immediate relevance to the clinical treatment of multiple behavior problems exhibited by children. Furthermore, the study of relationships between responses and the processes underlying these relationships can have important implications for understanding the complexity characteristic of human behavior not yet analyzed by behavioral research.

Behavior Therapy↗
PubMed1986

Treatment of fecal incontinence in children with spina bifida: comparison of biofeedback and behavior modification.

Two experiments compared the effects of biofeedback training to behavior modification in the treatment of 33 children aged 5 to 16 who had fecal incontinence secondary to myelomeningocele. Biofeedback involved providing visual feedback and rewards for successively stronger sphincter contractions during training sessions and requiring 50 sphincter contraction exercises daily. Behavior modification involved attempting to defecate immediately after the evening meal each day, receiving a reward for defecating in the toilet without an enema or suppository, and receiving an enema if unsuccessful for two consecutive days. In experiment I, eight children were offered biofeedback alone in an attempt to replicate previous studies. Biofeedback alone was found insufficient; addition of behavior modification was necessary. Experiment II systematically investigated the relative contribution of these two treatments. Overall, patients who received only behavior modification for three months showed as much clinical improvement as patients who received behavior modification plus biofeedback. This suggests that previous reports, because they have not controlled for nonspecific treatment effects, have overestimated the value of biofeedback in this population. However, a subgroup of patients (27%) were identified for whom biofeedback provided additional, specific benefit. These were children who had spinal cord lesions below L-2 and who initially had two or more bowel movements daily. The combination of behavior modification and biofeedback resulted in a greater than 50% reduction in the frequency of incontinence for 64% of patients, and results were well maintained at follow-up one year later.

Adolescent↗