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Biomedical subjects

T J Page

Publications and source records attributed to T J Page.

At least 19 recordsLinked to original sources
PubMed1998

Temporal distributions of problem behavior based on scatter plot analysis.

The scatter plot is a commonly used assessment tool for identifying temporal patterns in the occurrence of behavior problems. However, the extent to which such patterns are frequently observed is unknown because little research has evaluated the general utility of the scatter plot. We conducted a large-scale analysis of within- and across-day occurrences of problem behavior by conducting continuous observations of 20 individuals living in four residential facilities. Data were recorded during 30-min intervals throughout participants' waking hours for 30 days by direct care staff and were converted into scatter plot formats. Five sets of data were excluded from further analysis due to poor interobserver agreement (below 80%). Visual analysis of the remaining 15 scatter plots indicated that none showed any reliable temporal pattern of responding. However, when the data were transformed into aggregate "control charts" based on statistical process control procedures, 12 of the 15 sets of data revealed one or more 30-min intervals during which problem behavior was more likely to occur. Results are discussed in terms of the practicality of applying statistical analyses to scatter plot data and of collecting data for the length of time needed to show statistical significance. It was concluded that detailed functional or descriptive analyses, which would reveal cause-effect or correlational relationships between behavior and specific environmental events, may be both more precise and more efficient forms of assessment.

Adolescent↗
PubMed1997

A hexameric phosphorothioate oligonucleotide telomerase inhibitor arrests growth of Burkitt's lymphoma cells in vitro and in vivo.

A phosphorothioate oligonucleotide (PS-ODN) with sequence identical to the repeat sequence of the mammalian telomere, 5'-d(TTAGGG)-3', was incubated with a Burkitt's lymphoma-derived (OMA-BL1) cell line. This hexanucleotide inhibits telomerase activity in cell lysates, lengthens cell doubling time, and induces apoptosis. Concatenated repeats (12-, 18-, and 24-mers) of the 5'-d(TTAGGG)-3' motif induce similar cellular responses. Scrambled sequences do not efficiently inhibit telomerase activity or significantly alter cell growth and viability. The in vivo efficacy of this PS-ODN was evaluated in a xenograft human-nude mouse model. Once tumors were established these animals were administered the telomere mimic, 5'-d(TTAGGG)-3', a control scrambled sequence 5'-d(TGTGAG)-3', or saline for 14 days via a subcutaneous osmotic pumps in a blinded study monitoring tumor size with dose and time. A significant decrease in tumor size was observed in animals given 50 micrograms/mouse/day 5'-d(TTAGGG)-3', but not following 5'-d(TGTGAG)-3', relative to the saline-treated animals. The antitumor activity of the 6-mer telomere mimic demonstrated a dose dependency including a reduction in metastatic nodules in the spleen. No activity was observed with the scrambled controls. In addition to antitumor activity we observed an increase in the mouse hematopoietic progenitor cell populations, BFU-e and CFU-GM. These results demonstrated the effects of a short hexameric oligonucleotide telomere mimic in vitro and in vivo and the potential utility of short oligonucleotides as telomerase inhibitors.

Animals↗
PubMed1990

Teaching refusal skills to sexually active adolescents.

Refusal skills training was extended to sexually active handicapped female adolescents who lacked an effective refusal strategy. Role-plays for assessment and training were developed using the who, what, when and where of situations which resulted in unwanted intercourse. Refusal skills were trained following the format of rationale, modeling, rehearsal, feedback, and reinforcement. Baseline rates of most target behaviors were quite low. High frequencies of target behaviors were observed as each behavior became the focus of training. Generalization across staff and time was also observed. The skillfulness and effectiveness of the subjects' refusal skills were judged to be improved as a function of training. One-year follow-up showed decreased sexual activity for each girl.

Adolescent↗
PubMed1989

Assessing independent and interactive effects of behavioral and pharmacologic interventions for a client with dual diagnoses.

Behavior analytic methods were applied to the assessment and treatment of the problem behaviors of an 8-year-old male classified as having moderate mental retardation and atypical psychosis. Functional assessment procedures demonstrated that verbal behaviors diagnosed as hallucinatory were affected by environmental contingencies. Next, a multi-element/multiple baseline design was used to evaluate the independent and interactive effects of contingency management and pharmacologic interventions on three dependent variables: (1) psychotic speech; (2) aggressive-disruptive behavior; and (3) appropriate speech. Results indicated that contingency management without haloperidol was the most effective treatment for all inappropriate and appropriate behaviors. These results are important in that behavior analytic methods were shown to have utility for: (1) assessing the functional relationship between environmental contingencies and behaviors related to differential diagnosis; and (2) evaluating the independent and interactive effects of behavioral and pharmacologic treatments.

Autistic Disorder↗
PubMed1989

Teaching self-catheterization skills to children with neurogenic bladder complications.

We examined the effects of simulation training on the acquisition of self-catheterization skills in 2 female children with spina bifida. Based on a task analysis, the children were taught to perform on a doll each of the components of preparation, and, using a mirror to locate the urinary meatus, to insert and remove the catheter and to clean-up. Before, during, and after training, the children's performance of the skills on the doll and on themselves was assessed. Results of a multiple baseline design across subjects and skill components showed that doll training facilitated the children's acquisition of self-catheterization skills.

Behavior Therapy↗
PubMed1988

Enhancing child compliance with nebulized respiratory treatment. A case study.

A 2.7-year-old developmentally delayed boy diagnosed as having chronic lung disease, severe hyaline membrane disease, and persistent pulmonary hypertension with interstitial emphysema was referred in hopes of modifying his refusal to wear a mask during nebulized administrations of Chromolyn. The child was prescribed four 20-minute nebulized treatments daily but resisted treatment and removed the mask by turning his head and pushing the mask away with his hands. A procedure was implemented to gradually teach the child that turning his head and pushing the mask would not result in mask removal, and that by wearing the mask he would receive positive attention. By the end of treatment, the child was consistently wearing his mask for the required 20-minute intervals. Follow-up at 3 months confirmed maintenance of treatment effects.

Behavior Therapy↗
PubMed1986

Assessment and treatment of multiple behavior problems exhibited by a profoundly retarded adolescent.

The severe aggression and noncompliance of a profoundly retarded blind male were subjected to extensive behavioral assessment in order to identify controlling variables. The assessment, conducted across settings and therapists, suggested that these inappropriate behaviors functioned to avoid or terminate nonpreferred activities. Intervention consisted of manual guidance when there was noncompliance with instructions and edible reinforcement upon compliance; there were no direct contingencies for the inappropriate behaviors. Treatment procedures were implemented in a multiple baseline design across therapists and settings. Results show that the intervention consistently increased compliance, with concurrent decreases in inappropriate behaviors. Edible reinforcement and neuroleptic medication were withdrawn systematically with no loss of therapeutic gains. Family members and school personnel were trained to use the intervention procedures. Results are discussed in terms of functional assessment, response covariation, compliance training, parent and staff training, and behavioral assessment of the effects of neuroleptic medication.

Adolescent↗
PubMed1986

Analysis of environmental determinants of aggression and disruption in mentally retarded children.

This study evaluated methods for empirically identifying environmental determinants of aggressive and disruptive behavior in three developmentally delayed children. A variety of sessions conducted on an inpatient treatment unit were designed to stimulate contingencies maintaining aggression and disruption in the subjects' natural environments. The basic analog conditions included: instructional demands, contingent social disapproval, and structured play. In addition, variations of the three basic conditions were developed based on informal observation and parental reports of naturally occurring contingencies. Results showed considerable variability both between and within subjects. However, for each subject a specific analog condition was shown to produce relatively higher rates of aberrant behavior. Subsequently, behavioral treatments based on assessment results were successfully implemented with two of the subjects. Results are discussed in terms of the importance and practical limitations of conducting systematic assessment of aberrant repertoires in developmentally delayed clients.

Adolescent↗
PubMed1986

Simulation procedures for teaching independent menstrual care to mentally retarded persons.

Four mentally retarded adolescent females participated in a program for assessment and training of independent menstrual care skills. Three task analyses served as the basis for instruction: (a) menstrual stain on underwear, (b) menstrual stain on a sanitary pad, and (c) menstrual stain on both sanitary pad and underwear. During individual training sessions, subjects were taught to perform correct sequences via simulation training with a small doll, in which a trainer utilized instructions, praise, modeling, and corrective feedback. Three types of assessment probes were conducted prior to training, upon completion of specified mastery criteria, and during post-training follow-up sessions. Doll probes assessed performance with the toy doll, self-probes assessed naturalistic performance but under conditions of simulated menstruation, and in vivo probes assessed performance during actual menstruation. Results of a multiple baseline analysis indicated that subjects emitted few correct responses during baseline probes, but showed consistent improvements that corresponded to the introduction of training. Generalization to untrained skills was noted with all subjects. Follow-up assessments indicated maintenance of skills for periods up to 30 weeks following termination of training.

Activities of Daily Living↗
PubMed1986

Effectiveness of brief time-out with and without contingent delay: a comparative analysis.

We evaluated a commonly used component of brief time-out, in which release from time-out is delayed contingent on the occurrence of disruption. Data were collected for one normal and two mentally retarded children on time-out-producing behaviors (aggression and disruption) as well as delay-producing behaviors during time-out (loud vocalizations, out-of-chair, aggression, and disruption). The results of a combination ABAC reversal and multiple-baseline design indicated that, under the conditions used in this investigation, both delay and no delay variations were effective in reducing the frequency of the target behaviors. Implications for the use of time-out to reduce aberrant behaviors are discussed.

Adolescent↗
PubMed1985

Assessment of stimulus preference and reinforcer value with profoundly retarded individuals.

We evaluated a procedure for identifying potential reinforcers with profoundly retarded individuals. In Experiment 1, six persons were repeatedly exposed to 16 stimuli, and approach behaviors to each stimulus were used to identify preferred and nonpreferred stimuli. In Experiment 2, we examined the reinforcing properties of preferred and nonpreferred stimuli by delivering them contingently on the occurrence of arbitrarily selected responses. Results revealed that the preferred stimulus conditions typically produced higher rates of responding than did either the baseline or the nonpreferred stimulus conditions, suggesting that the procedure can be used to assess reinforcer value for individuals with limited behavioral repertoires.

Adolescent↗
PubMed1985

Clinical behavioral pharmacology: methods for evaluating medications and contingency management.

We evaluated methods for comparing the effects of dextroamphetamine (Dexedrine), thioridazine (Mellaril), and contingency management in the control of severe behavior problems. A reversal design was used in which medications were systematically titrated and assessed in unstructured as well as structured settings with three clients. Subsequently, behavioral procedures including timeout, differential reinforcement of other behavior, and visual screening, were used in a multiple-baseline design across settings. The assessment and design methods were useful in comparing the interventions. Dextroamphetamine decreased inappropriate behaviors and improved academic behaviors in one client, but no reliable effects were observed in the other two clients. Thioridazine was variable across clients, settings, behaviors, and dosages. Contingency management produced consistent decreases in inappropriate behaviors and small improvements in academic performance.

Achievement↗
PubMed1983

Reduction of food theft and long-term maintenance of weight loss in a Prader-Willi adult.

Behavioral interventions have had limited success in managing the chronic hyperphagia and obesity that are of presumed organic etiology in Prader-Willi syndrome. Thus, frequent foraging for food and covert consumption continue to be health-threatening problems for many Prader-Willi individuals. This case study was designed to replicate methods for assessment and treatment of food theft. A token program based on differential-reinforcement-of-other-behavior and response-cost eliminated theft in three hospital settings. Prior to discharge, the program was expanded to include contingencies on exercise behavior and weight loss, and staff from the subject's group home residence were trained to implement a modified program in the natural environment. Reduced food theft and continued weight loss were maintained in the group home and an apartment-living arrangement. A total of 81 lb (37 kg) was lost during a 2-yr period.

Adult↗
PubMed1983

Assessment and reduction of food stealing in Prader-Willi children.

A common behavior problem among Prader-Willi children is inappropriate foraging for food. Theft and subsequent consumption often go undetected and contribute to morbid obesity in many of these individuals. In this study an observational methodology was developed to assess food stealing in two children with Prader-Willi syndrome. The children were observed to steal food at a high rates under baseline conditions in three hospital settings. Subsequent treatment, based on differential reinforcement of other behavior (DRO), consisted of reinforcement of nonstealing at the end of progressively lengthening intervals, and was implemented in multiple baseline fashion across both subjects and settings. Results showed that both subjects' stealing rapidly ceased in treated settings, but failed to show generalization to untreated settings. Follow-up data collected in one setting after termination of active intervention reflected continued nonoccurrence of food stealing, although long-term weight data were not encouraging. Results are discussed in terms of their methodological contribution to the study and treatment of Prader-Willi syndrome.

Behavior Therapy↗
PubMed1982

Pyramidal training: a large-scale application with institutional staff.

This study evaluated an indirect method of training 45 institutional direct care staff to conduct behavioral programs. Three supervisors were trained to improve teaching behaviors (instructions, prompts, and consequence) used by the direct care staff while working with severely and profoundly handicapped residents. In addition to training, daily feedback was provided to supervisors regarding performance of their staff. Results of a multiple baseline analysis across teaching behaviors (instructions, prompts, and consequences) and content areas (communication and gross motor skills) showed that providing training and feedback to supervisors resulted in increases in correct teaching behavior by direct care staff. However, teaching behavior newly learned in one content area (communication) did not generalize to the other area (gross motor skills). Data collected on resident behavior showed small but noticeable improvement in terms of correct responses and attending behavior during programming. Results are discussed in terms of the benefits of a pyramidal approach to training institutional staff.

Adolescent↗
PubMed1981

Teaching the handicapped to eat in public places: acquisition, generalization and maintenance of restaurant skills.

This study examined classroom-based instruction in restaurant skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.

Adolescent↗
PubMed1981

Evaluating a supervision program for developing and maintaining therapeutic staff-resident interactions during institutional care routines.

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.

Child↗