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From the beginning of recorded time human beings have assigned blame to persons who misbehave. The first prominent person to make an alternative case was Father Edward J. Flanagan, the founder of Boys Town, who proclaimed there was "no such thing as a bad boy, only bad environment, bad modeling, and bad teaching" (Oursler & Oursler, 1949, p. 7) in other words, bad circumstances. This paper will refer to this perspective as the Circumstances View of problem behavior and anchor it as the foundational idea for the field of behavior analysis. This paper will discuss the origins of the Circumstances View, the benefits that result from its adoption, reasons why its adoption is not more widespread, and suggestions for disseminating it more widely.

This article addresses the essential role of sleep in the medical, emotional, behavioral, and cognitive health of children. Sleep disorders common among children are defined along with the most common sleep concerns reported by caregivers. Prevention and intervention strategies are described.

This article addresses the essential role of sleep in the medical, emotional, behavioral, and cognitive health of children. Sleep disorders common among children are defined along with the most common sleep concerns reported by caregivers. Prevention and intervention strategies are described.

The endpoint of the alimentary process involves elimination of urine and feces and these processes represent a common developmental milestone for children; however, failure to achieve appropriate elimination by the expected age is a common pediatric complaint. Specifically, enuresis (urine) and encopresis (feces) are estimated to occur in approximately 25% of 6-year old children. It has been noted by several authors that the prevalence is higher in boys than girls and that rates decrease as a function of age (Friman, 2008; Shepard & Cox, 2017). These disorders usually occur independently but can co-occur. There is a broad range of medical conditions that can cause encopresis and enuresis, but these causes are rare. They are real, however, and need to be ruled out prior to going forward with behavioral assessment and treatment. The vast majority of cases are functional and their comprehensive assessment readily yields functionally relevant variables that can either be modified or manipulated through behavioral intervention to bring about modifications in behavior related to elimination.

Incontinence in childhood in either of its forms, enuresis and encopresis, is one of the most prevalent and distressing of all childhood problems. Due to widespread misunderstanding, incontinence is a significant precipitating factor in the mistreatment of afflicted children. Interpretations of and treatments for enuresis and encopresis have shifted in the past few decades from a mostly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of incontinence are medical/organic, environmental and psychosocial elements are factors, and the most empirically supported treatments have a significant behavioral dimension. This chapter reviews the literatures on enuresis and encopresis with attention focused on clinical description, causes and correlates, assessment, treatment, challenges, and implications for practice. Case examples are included to illustrate these features.

Primary pediatric medical care is as mainstream as any major cultural practice in the USA. Thus, publishing behavior analytic papers that pertain to problems that present in pediatric settings in pediatric medical journals is one route to mainstream relevance. With sufficient numbers of such papers, it could even lead to prominence. This article describes examples of publishing in pediatric journals and some lessons I learned from the experience. For example, (1) all child behavior problems that present in pediatric settings are of social importance but most are high-frequency, low-intensity problems that are not necessarily exotic or representative of serious pathology, and they usually respond to straightforward behavioral applications; (2) it is usually best to use a "colloquialized version of learning theory" when writing for and speaking to pediatric providers (and the families for whom they provide care); (3) pediatricians often have limited knowledge about behavior analytic research designs; and (4) when submissions are rejected by pediatric journals, the rejection can be exploited as an opportunity to educate pediatric editors and reviewers.

The foundational idea of behavior analysis is that behavior is a function of environmental circumstances, past and present. It is the most powerful idea ever invented by mankind for understanding, knowing, and approaching human behavior, especially problem behavior. Yet the idea itself is not well known, understood, or used. In other words, it has not been disseminated widely or well. The chapters of this book focus on how to improve this state of affairs. This chapter recommends mastering, or at least becoming more competent at, the front of the room, a very powerful locus for disseminating information. As I have previously asserted mastering it can turn a commoner into a king, a middling man into a mayor, or a group of disorganized, dispirited people into an energized force marching into battle. More specific to this book, it can also transform you into a powerful disseminator. In this paper I define what I mean by the front and I supply 25 suggestions for improving your performance while you are there. My specific intent is to improve your performance in front of audiences and my general intent is to improve your function as an ambassador for our field.

Mainstream prominence was Skinner’s vision for behavior analysis. Unfortunately, it remains elusive, even as we approach the 110th anniversary of his birth. It can be achieved, however, and there are many routes. One that seems overlooked in many (most?) behavior analytic training programs is what I call the front of the room. The front of the room is a very powerful locus for influencing people. Mastering it can turn a commoner into a king; a middling man into a mayor; or a group of disorganized, dispirited people into an energized force marching into battle. The most powerful members of our species had their most memorable moments at the front of the room. If so much is available there, why is mastery of it in such short supply, not just in behavior analysts but in the population at large? In this paper, I address why, argue that the primary reason can be overcome, and supply 15 behaviorally based steps to take in pursuit of front of the room mastery.

At last, the field of applied behavior analysis has a beautifully crafted, true textbook that can proudly stand cover to cover and spine to spine beside any of the expensive, imposing, and ornately designed textbooks used by college instructors who teach courses in conventional areas of education or psychology. In this review, I fully laud this development, credit Cooper, Heron, and Heward for making it happen, argue that it signifies a checkered flag for students and professors, and recommend the book for classes in applied behavior analysis everywhere. Subsequently, I review its chapters, each of which could easily stand alone as publications in their own right. Finally, I supply a cautionary note, a yellow flag to accompany the well-earned checkered flag, by pointing out that, as is true with all general textbooks on applied behavior analysis, a major portion of the references involves research on persons who occupy only a tail of the normal distribution. To attain the mainstream role Skinner envisioned and most (if not all) behavior analysts desire, the field will have to increase its focus on persons who reside under the dome of that distribution.

Functional encopresis (FE) refers to the repeated passage of feces into inappropriate places at least once per month for at least 3 months. Treatment of FE targets the processes that cause or exacerbate the condition, including reduced colonic motility, constipation, and fecal impaction. The cardinal elements of successful treatment include "demystifying" the elimination process, bowel evacuation, stool softeners, prompts and reinforcement for proper toileting habits, and dietary modifications. Despite misinformation and misinterpretations of encopresis, the assessment and treatment of this condition actually represent one of the more successful achievements of behavior therapy. Keywords: Encopresis, constipation, fecal incontinence. Introduction Functional encopresis (FE) is a common, under-treated and often over-interpreted elimination disorder in children. Although all forms of incontinence require evaluation and treatment, when left untreated FE is more likely than other forms, such as enuresis, to lead to serious and potentially life-threatening medical sequelae and impaired social acceptance, relations, and development. The reasons for the medical sequelae will be summarized briefly below. The primary reason for the social impairment is that soiling evokes more revulsion from peers, parents, and caretakers than other forms of incontinence (and most other behavior problems). As an example, severe corporal punishment for fecal accidents was still recommended by professionals in the late 19th century (Henoch, 1889). Evidence-based practices in the treatment of FE have evolved substantially since then, but the approaches by lay persons (and still some professionals) have not kept pace. Children with FE are still frequently shamed, blamed, and punished for a condition that is most often beyond their control (Christophersen & Friman, 2004; Friman, 2003; Friman & Jones, 1998; Levine, 1982). The definition of FE has remained relatively consistent across versions of the DSM; the DSM-IV (American Psychiatric Association, 1994) lists four criteria for FE: (1) repeated passage of feces into inappropriate places whether involuntary or intentional; (2) at least one such event a month for at least 3 months; (3) chronological age is at least 4 years (or equivalent developmental level); and, 4) the behavior is not due exclusively to the direct physiological effects of a substance or a general medical condition except through a mechanism involving constipation. The DSM-IV indicates that approximately 1% of five-year-olds meet the criteria for encopresis, and males are affected more frequently than females. There are a number of classification schemes for encopresis, but the system most commonly used employs a retentive versus nonretentive dichotomy. Retentive encopresis is defined as fecal soiling with constipation and overflow incontinence, whereas nonretentive encopresis occurs without constipation and overflow incontinence (American Psychiatric Association, 1994). Christophersen and Mortweet (2001) describe constipation as the passage of large or hard stools, often accompanied by complaints of abdominal pain, infrequent bowel movements (fewer than three per week), the presence of abdominal masses upon physical examination, and emotional upset before, during, and after defecation. Constipation is present in approximately 95% of children referred for treatment of encopresis, indicating that retentive encopresis is far more common than the nonretentive classification (Loening-Baucke, 1996). Prevalence Current prevalence rates for the occurrence of encopresis are scarce, and many commonly cited figures are based on studies conducted three or even four decades ago. Recent investigations indicate that the prevalence of encopresis is between 1% to 4% of children, depending on the source and age reported. A Swedish population-based study found that 0. …

This article presents results from an investigation using functional assessment strategies in a general education classroom for an early adolescent diagnosed with ADHD/ODD. In the first phase of the assessment, data were collected from teacher interviews, student interviews, and direct observations to generate hypotheses regarding the association between classroom environmental conditions and the occurrence of disruptive behavior. The hypotheses were then evaluated in the context of regularly occurring classroom activities. Based on the data obtained through the functional assessment procedure, a classroom intervention was designed, implemented, and evaluated. Results indicated the intervention was successful in decreasing the participant's disruptive behavior. Further, the teacher and student reported high acceptability for the assessment and intervention. Project findings are discussed in terms of bridging the gap between research and practice, conducting a functional behavioral assessment (FBA) within applied settings, and the use of FBA for behaviors that are potentially under the control of multiple maintaining functions. ********** An unprecedented amount of attention has been devoted to functional behavioral assessment (FBA) methodologies in recent years. Driven in part by the reauthorization of the Individuals with Disabilities Education Act (IDEA P.L. 105-17), debate in the field of special education has centered on the mandated use of functional behavioral assessment in various situations (Watson, Gresham, & Skinner, 2001). However, recent reviews of the empirical literature have led some scholars to argue that there has not been sufficient field testing of FBA methodology in natural school contexts to warrant its mandated use in school settings (Nelson, Roberts, Mathur, & Rutherford, 1999). Nonetheless, other scholars contend that there is conceptual soundness and a substantial literature supporting the use of FBA in school settings (e.g., Ervin et al., 2001; Sugai, Horner, & Sprague, 1999). Despite differing views on the mandated use of FBA in school settings, there is relative agreement on the need to move from research to practice in FBA. Further, the mandated use of FBA is likely to generate more applied research on this method. In this article, a rationale is provided for moving from research to practice in FBA as well as a school-based example of how one might approach this extension. The rise of legal mandates and suggestions of "best practices" regarding FBA in the schools has led to a number of criticisms. At the forefront are concerns that functional assessment research is limited in scope (e.g., Ervin et al., 2001; Howell & Nelson, 1999; Nelson et al., 1999). The majority of research on FBA for intervention planning involves persons with developmental disabilities, and the amount of research focused on FBA for students with high-incidence disabilities (e.g., disruptive behavior, EBD, ADHD, LD) is modest by comparison. In fact, one literature review indicated only 18% of school-based FBA studies were with students with disruptive behavior disorders, compared to 70% for students with cognitive impairments (Ervin et al., 2001). Additionally, the majority of demonstrations of FBA in the classroom have been conducted under highly controlled conditions rather than more natural contexts of the ongoing classroom routine. Although a more restricted or analogue setting may allow for greater experimental control of environmental variables in a given study, external validity is compromised (Gresham, Watson, & Skinner, 2001). Finally, an analysis of the empirical literature on FBA reveals that classroom personnel have been less involved in the hypothesis testing phase of the FBA process; instead, the experimenter typically conducts any experimental manipulations (Ervin et al., 2001). Although a handful of studies have demonstrated that teachers and school staff can be trained to conduct all phases of an FBA (e. …

Nocturnal enuresis is one of the most prevalent and distressing of all childhood problems. The treatment of nocturnal enuresis has shifted in the past few decades from a strictly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of this disorder are medical/organic, there is currently strong evidence for a behavioral treatment package consisting of the urine alarm and various skillsoriented components. Alternative devices, methods, and adjunctive components are reviewed and presented in the context of an optimal treatment plan.

Little research has been published on tattling, even less on its social impact, and we found none directly investigating tattling by adolescents. This study assessed the extent to which tattling, as perceived by peers and caregivers of adolescents in a residential care program, was associated with various dimensions of social status and other behavioral correlates. Eighty-eight adolescent participants rated their housemates on likeability, perceived rates of tattling, and other behavioral descriptors. In addition, caretakers also rated each youth in terms of perceived tattling. On the basis of likeability ratings, participants were classified into one of five categories: popular, average, controversial, neglected, and rejected. Results showed a significant negative correlation between likeability and perceived tattling rates. In addition, youth classified as socially rejected were more likely to be perceived by both their peers and care providers as engaging in high rates of tattling.

The purpose of this study was to assess the concurrent criterion validity of the attention-deficit/hyperactivity disorder (ADHD) portion of the National Institute of Mental Health Diagnostic Interview Schedule for Children–IV (NIMHDISC-IV). Fifty-seven adolescent participants were divided into three groups on the basis of whether participants met criteria for ADHD on caretaker and adolescent responses on the DISC: (a) 18 participants for whom both the caretakers and adolescents endorsed ADHD, (b) 17 participants for whom the caretakers but not the youth endorsed ADHD, and (c) a clinical control group with no ADHD diagnosis ( n = 22). These three groups were compared across parent, teacher, and adolescent checklists; clinician diagnosis; and three objective measures of behavior (continuous performance task, actigraphy monitoring, and a structured observation). Findings lend partial support to the concurrent criterion validity of the ADHD section of DISC.

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the “nonresponse” of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.

Branch and Vollmer (2004) argue that use of the word behavior as a count noun is ungrammatical and, worse, mischaracterizes and ultimately degrades the concept of the operant. In this paper I argue that use of behavior as a count noun is a reflection of its grammatical status as a hybrid of count and mass noun. I show that such usage is widespread across colloquial, referential, and scientific documents including the writings of major figures in behavior analysis (most notably B. F. Skinner), books describing its applications, and its major journals. Finally, I argue against the assertion that such usage degrades the concept of the operant, at least in any meaningful way, and argue instead that employing eccentric definitions for ordinary words and using arcane terms to describe everyday human behavior risks diminishing the influence of behavior analysis on human affairs.

Diaper use is widespread and possibly even increasing across diverse populations in the United States, ranging from infants to very old adults. We found no reports of an experimental analysis of the effect of wearing diapers on the frequency of urinary accidents and the attainment of continence skills (e.g., urinating in the toilet). In this study, we used a withdrawal design to evaluate the effect of wearing diapers on daily urinary accidents and successful voids for an adult who had been diagnosed with mental retardation. Results indicated that wearing diapers increased the rate of accidents and decreased the rate of successful voids. Clinical implications of these results are discussed.

Simplified regulated breathing (SRB) has been demonstrated to reduce or eliminate stuttering in children. However, much of the current research has evaluated the intervention with school-aged children within educational contexts. In the current case report, we extended the application of SRB by evaluating its effectiveness in treating stuttering displayed by a 15-year-old resident of a large midwestern residential facility. Further, we evaluated the impact across different assessment conditions. Results showed that SRB resulted in decreased stuttering for the participant, although differential effectiveness across conditions was noted. These results are discussed in terms of the generality of SRB across client populations and clinical settings, as well as the value of addressing contextual variables when treating stuttering.

This case study describes the use of functional assessment in combination with experimental functional analysis as methods for informing and evaluating individualized treatment in a large residential treatment setting for adolescents. The case of John, a normally developed 12-year-old male, illustrates how functional information can be used to derive a simple treatment that can be effective in modifying previously intractable and highly disruptive behavior. Challenges associated with maintenance of treatment over time are described in relation to John’s follow-up status. Finally, recommendations are made about the utility of functional methodologies within residential care settings and the need for ongoing experimental evaluation testing limits of such methodologies.

This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.

Objective To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. Method Secondary data analysis of a large epidemiological data set ( n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample ( n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents ( n = 128) and/or adolescents ( n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Results All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power. Conclusions The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

The authors provide three case examples of the evaluation of assessment-based intervention strategies within the natural classroom context for students with attention deficit hyperactivity disorder (ADHD) and comorbid disorders. For each of the participants, several hypotheses were generated concerning potential environmental correlates of undesirable behavior based on information obtained during student and teacher interviews as well as descriptive observations. The utility of these assessment-based, nonintrusive intervention strategies was evaluated within the natural context and ongoing routine of the classroom using an alternating-treatments design. For each participant, results demonstrated that assessment-based environmental modifications can decrease problematic classroom behaviors. In addition, results of the hypothesis testing suggested feasible and effective classroom intervention strategies.

Using recently refined diagnostic criteria, the authors hypothesized that the frequent touching of others by a 16-year-old male adolescent with Tourette's syndrome was a compulsion and not a tic. Consistent with the study's hypothesis, the authors applied exposure and response prevention, a procedure empirically supported for treatment of compulsions but not for tics, to the touching. Results showed a significant decrease in touching attempts, overt anxiety, and subjective anxiety across time.

This brief comment presents my clinical interpretation of the problems presented by Mike, a 13-year-old Caucasian male living at Boys Town, as described in his case description. My perspective on the case is behavior analytic, and my interpretation is that it involves profound social-skills deficits. To begin, I recommend a comprehensive functional assessment including an interview with Mike. Cautiously, in lieu of information from that assessment, I recommend a 6-point treatment plan including a carefully selected therapist, two types of positive peer reporting, a group approach to social-skills training, and staged and unstaged practice of target social skills.

Group intervention for antisocial youth has received harsh criticism in recent years. This paper reviews relevant research focused on the influence of contact with delinquent peers on the development of antisocial activity. Also reviewed are studies reporting outcomes of group intervention for antisocial youth. Although a few studies have found iatrogenic effects for group intervention with antisocial youth, the majority have not. Well-developed models of group intervention have produced substantial reductions in youth antisocial activity. We describe one such program, a family-style residential program based on behavioral learning principles, and review outcomes of this program. We conclude that treatment of antisocial youth in groups is feasible and can be effective in reducing delinquent behavior.

We administered the Diagnostic Interview Schedule for Children (DISC) two times to a group of youth (222 boys, 147 girls) entering residential care, once at their time of entry and once 1 year later. We then compared their DISC outcomes on Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) against changes in independent direct observations of diagnostically relevant behavior obtained over the course of that year. Results from hierarchical linear modeling analyses showed significant discriminative relationships between results from the DISC and the independent observations. Specifically, observations of symptomatic behaviors (CD or ODD) decreased for youth who met diagnostic criteria at the first administration of the DISC but not at the second, increased for youth who did not meet criteria at the first administration but did at the second, and did not change for youth who met criteria at both administrations. These results extend the data on the validity of the DISC and support continued research efforts to determine its clinical utility.

This study used a multielement baseline design to analyze the effects of token rewards delivered contingent upon completion of math problems by 2 middle-school boys. Time spent on math and number of work pages completed increased (with high accuracy) during reward conditions and were maintained during fading and withdrawal. At followup, time spent and work pages completed remained well above baseline for 1 boy and fell below for the other, while accuracy remained high and ratings of liking math were the highest possible for both boys. Overall, the results are inconsistent with warnings about use of token rewards to motivate children. DESCRIPTORS: reinforcement, motivation, token economy, mathematics

This study compared scores on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for samples of youths in 3 out-of-home placements with varying levels of restrictiveness. Mean CBCL T scores were more than a standard deviation higher than mean YSR T scores on the broadband scales and about 2/3 of a standard deviation higher on the syndrome scales. The magnitude of the discrepancy varied between placements for several scales, with the least restrictive placements having the largest difference between CBCL and YSR ratings for the Externalizing scale. For the Internalizing scale, the discrepancy was larger for older youths (ages 15-18) than for younger youths (ages 11-14). These results support previous findings that in clinical samples, adults rate children's behavioral and emotional problems as more severe than do children themselves. This study extends prior research by demonstrating the occurrence of this discrepancy across a continuum of care.

My heroes have always been cowboys. This is true (and also the name of a song written by Willie Nelson). Now, however, my heroes are behavior analytic researchers. They have provided the conceptual and empirical floorboards for behavior analysis, my beloved and chosen field. They have inspired, motivated, and vitalized me throughout my career and still do so. I seek them out, strive to emulate them, and consult their astonishing treasure trove of findings with a regularity that sometimes seems obsessive. So, I find myself conflicted now because I am compelled to stand up for behavior analytic practice. The timely and well-conducted study of publication stats on faculty in Behavior Analyst Certification Board (BACB) programs motivated me to do so. In an insidiously oblique way, the study reflects the bias I perceive favoring research over practice in psychology programs across the country. That bias, implicit in most programs, and explicit in many, does not exist in medical school. Students go to medical school to learn to practice medicine, first and foremost. Some go on to research careers but the primary goal, encouraged strongly by the faculty, is the successful practice of medicine. It is quite the reverse in psychology programs, at least in top tier schools. Practice is not frowned upon; it is merely looked upon as a lesser endeavor. The tacit view seems to be that those who can, research and teach, and those who cannot, practice. Ironically, this is the reverse of the longstanding quote, sometimes used against teaching in the colloquial world (“those who can, do, those who cannot, teach”). It may be the case that research faculty are merely trying to accomplish either or both of two goals: replicating themselves or furthering their lines of scientific investigation. Students pursuing research careers can contribute to both goals, students pursuing practice, not so much.

A key concept in the continuum-of-care model is matching the restrictiveness of treatment to the level of youth behavior problems. Restrictiveness refers to the degree that treatment and setting constrains choices and limits freedoms of patients. Only a few investigators have examined this relationship, and the findings have been equivocal. Extending our initial study of the relationship between youth behavior problems and program restrictiveness, we examined the relationship across seven programs spanning the continuum of care: parent training program, outpatient clinic, family preservation program, treatment foster care, residential group home, acute-care shelter, and inpatient psychiatric hospital. Results indicated a high level of correspondence between restrictiveness and youth behavior problems, with the least restrictive programs serving children with fewer behavior problems and highly restrictive programs serving children with more behavior problems.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.

An intervention for disruptive boys in residential care involving increases in positive to negative interactional ratios is described. The target of the intervention was daily problem behavior. Results from a pooled time series analysis of the data revealed a significant decrease in behavior problems (one problem per boy per day) during the intervention for the boys as a group. Results from comparisons of mean behavior problems during baseline and intervention revealed decreases for five of the six boys. Results from a multiple baseline across boys revealed experimental control for three of the six. The results are discussed in terms of response contingent reinforcement and systemic behavior analyses. The benefits of combined group and single subject data analyses are also discussed.

There is much to admire in this report of an adaptation of parent-child interaction therapy (PCIT) used to treat a uniquely complex case involving comorbid reactive attachment and oppositional defiant disorders. One the one hand, the paper reflects the remarkable potency and flexibility of PCIT. On the other hand, it reflects the clinical acumen and interpersonal dexterity of the clinicians who reported the case. We will discuss both of these aspects below....

We evaluated a program to protect the placements of 23 highly troublesome youth in voluntary residential care by reducing youth-to-staff ratios. Specifically, the youth were moved from regular program homes (with eight youth) to reduced ratio homes (with only four youth) instead of being terminated from the program. We provide evidence supporting the assertion that youth in the study sample were highly troublesome and at high risk for program failure and more restrictive placements. Placement in the reduced ratio homes protected the trouble youths' placement, resulting in an additional mean length of stay of 950 day without an increase in program restrictiveness. Further, the reduced ratio homes increased the chances of success in the program for the study sample to a level equivalent to that for the much less troubled comparison sample. Cost estimates are also provided.

There is extensive literature on disruptive behavior and on anxiety and a growing literature on co-morbidity. But there is little literature on co-morbidity between disruptive behavior and anxiety, and we found none that specifically discusses social phobia. Because internalizing problems are more difficult to detect than externalizing problems, the latter may obscure the former when they occur together, especially with subtle internalizing problems such as social phobia. We present a case involving co-morbidity between disruptive behavior and social phobia in a 14-year-old boy in residential care. Treatment for social phobia, involving modified public interactions, social-skills training, exposure and reinforcement-based feedback, reduced a high rate of disruptive behavior to near-zero rates.

To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The interviews included five scales reflecting youths' views about important aspects of their lives in placement: (1) Delivery of Helpful Treatment, (2) Satisfaction with Supervising Adults, (3) Isolation from Family, (4) Isolation from Friends, and (5) Sense of Personal Control. Hierarchical linear modeling allowed us to estimate group differences while controlling for developmental trends, demographic factors, and prior differences between groups. The two groups were equivalent on all scales before the study. During the following placement, however, the treatment group's ratings were significantly more positive than the comparison group on four of the five scales and approached significance on the fifth. These findings suggest that negative beliefs about life in residential placement for adolescents may not apply to all programs.

School performance and attitudes of a group of children placed in residential care were assessed during placement and for an average of four years after discharge. A comparison group of children who were not placed in the program was also followed. The residential program emphasized both behavioral and educational treatment. Group differences were tested using Hierarchical Linear Modeling (HLM). Results indicated that the treatment group had significantly greater improvements in both school performance and attitudes during placement. These differences were also maintained after discharge. It is suggested that long-term educational effects with troubled children may require an intensive intervention over an extended period of time.