Oppositional Defiant Disorder and Aggression in a Young Man with Mental Retardation: Long-Term Treatment in a Community-Based Setting

A longitudinal, intensive treatment program is described that was implemented over an 8-year period in a community-based setting for a young man with mental retardation and oppositional defiant disorder with severe physical aggression. The development of this disorder and its systematic treatment are described, with new components added based on improvement in the individual’s behavior. The individual made steady progress and has maintained good behavioral stability for the final three years of the treatment program. This paper highlights the inherent difficulties of applying empirically validated treatment strategies in community-based settings

A Community-Based Accommodation Program for Adults with Autism and Mental Retardation

There is a paucity of treatment literature for significant and intractable behavior problems in adults with autism and mental retardation. Four adults with autism, severe to profound mental retardation, and serious, long-term behavior problems participated in an accommodation training program as an adjunct to more traditional behavioral and medical treatments. The accommodation program consisted of designing highly structured and predictable daily routines to reduce the impact of environmental factors that had previously resulted in behavior problems. Following three to six years of participation in the accommodation program, a significant treatment effect size was obtained for all participants. The benefits of this approach for improving the treatment-resistant problem behaviors and quality of life for adults with autism and mental retardation in a community-based setting are discussed as well as directions for future research

Incidence of Behavior Problems in Toddlers and Preschool Children from Families Living in Poverty

Few studies have examined the incidence of behavior problems in toddlers and preschool children from families living in poverty. The available research suggests behavior problems occur at higher rates in children living in poverty and may have long-term negative outcomes if not identified and properly treated. This study included an ethnically representative sample of 357 children, five years of age and younger, from a diverse, low-income, urban area. All families’ incomes met the federal threshold for living in poverty. Behavior problems were assessed by parent report through a questionnaire specifically designed for low-income families. Boys and younger children were reported as demonstrating a higher rate of externalizing behaviors than girls and older children. The overall rate of children scoring at least one standard deviation above the sample\u27s mean for challenging behaviors was 17.4% and was not related to the child\u27s gender, age or ethnicity. This study also sampled children\u27s positive behaviors, which is unique in studies of behavior problems. Gender and age were not related to the frequency of reported positive behaviors. Ethnicity did influence scores on the positive scale. African American children appeared to present their parents more difficulty on items reflecting cooperative behaviors than Caucasian or Latino children. The implications of the study are discussed based on the recognized need for universal screening of behavior problems in young children and the small number professional training programs targeting the identification and treatment of early childhood behavior problems, despite the availability of evidence-based treatment programs tailored to young children in low-income families

Screening for Significant Behavior Problems in Diverse Young Children Living in Poverty

The development and use of first line screening instruments is an essential first step in assessing behavior disorders in very young children. The Early Childhood Behavior Screen (ECBS) is a parent-report measure for behavior disorders and is normed on young children (1–5 years old) living in poverty. The current study presents psychometric support for the discriminative validity of the ECBS’s 10-item Challenging Behavior Scale (CBS) as a first-line screener for externalizing behavior problems for preschool aged-children in poverty. The study’s sample included 673 participants (M age years = 2.81; 63.2 % male; 65.8 % African American) that all met the federal definitional standard for living in poverty. A confirmatory factor analysis was run to provide support for the ECBS factor structure. Receiver operating characteristics (ROC) curve analyses were used to test the CBS’s ability to distinguish between 428 clinic-referred children and 245 non-clinic-referred children. Results showed an acceptable fit model for the ECBS, providing further evidence of its construct validity. Optimal cut-scores by child age derived from the ROC curve analyses were provided with corresponding levels of sensitivity, specificity, and positive and negative predictive values. Sensitivity rates for cut scores ranged from 0.76 to 0.83 and specificity rates ranged from 0.88 to 0.95. Acceptable test–retest reliability and good internal consistency also was observed. The CBS quickly identifies young children from low-income, urban, diverse populations that may be at-risk for developing significant behavior disorders and should be considered by health care professionals who work with very young children

Behavior Problems in Toddlers With and Without Developmental Delays: Comparison of Treatment Outcomes

The purpose of this study is to examine the effectiveness of an in-home parent management program for toddlers with behavior problems and developmental delays by comparing outcomes for a group of toddlers with developmental delays (n = 27) and a group of toddlers without developmental delays (n = 27). The majority of children lived in single parent, low-income homes. Results suggest that the parent management program is equally effective for children with and without developmental delays. Parents from both groups reported clinically significant improvement in their children\u27s behavior and parenting practices. Clinical implications regarding the importance of these findings for improving outcomes for toddlers with behavior problems and developmental delays living in poverty were discussed