Bull Leah E, Oliver Chris, Woodcock Kate A
Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
J Behav Ther Exp Psychiatry. 2017 Mar;54:58-70. doi: 10.1016/j.jbtep.2016.06.006. Epub 2016 Jun 22.
BACKGROUND & OBJECTIVES: Several neurodevelopmental disorders are associated with resistance to change and challenging behaviours - including temper outbursts - that ensue following changes to routines, plans or expectations (here, collectively: expectations). Here, a change signalling intervention was tested for proof of concept and potential practical effectiveness.
Twelve individuals with Prader-Willi syndrome participated in researcher- and caregiver-led pairing of a distinctive visual-verbal signal with subsequent changes to expectations. Specific expectations for a planned subset of five participants were systematically observed in minimally manipulated natural environments. Nine caregivers completed a temper outburst diary during a four week baseline period and a two week signalling evaluation period.
Participants demonstrated consistently less temper outburst behaviour in the systematic observations when changes imposed to expectations were signalled, compared to when changes were not signalled. Four of the nine participants whose caregivers completed the behaviour diary demonstrated reliable reductions in temper outbursts between baseline and signalling evaluation.
An active control group for the present initial evaluation of the signalling strategy using evidence from caregiver behaviour diaries was outside the scope of the present pilot study. Thus, findings cannot support the clinical efficacy of the present signalling approach.
Proof of concept evidence that reliable pairing of a distinctive cue with a subsequent change to expectation can reduce associated challenging behaviour is provided. Data provide additional support for the importance of specific practical steps in further evaluations of the change signalling approach.
多种神经发育障碍与抗拒改变及挑战性行为相关，包括在日常安排、计划或期望（此处统称为期望）发生变化后出现的发脾气行为。在此，对一种变化信号干预措施进行了概念验证测试及潜在实际效果测试。
12名普拉德-威利综合征患者参与了由研究人员和护理人员主导的将独特的视觉-语言信号与随后的期望变化进行配对的过程。在极少受干扰的自然环境中，系统观察了对5名参与者计划子集的特定期望。9名护理人员在为期四周的基线期和为期两周的信号评估期内完成了发脾气日记。
与未发出信号时相比，当对期望的改变发出信号时，参与者在系统观察中发脾气行为持续减少。9名护理人员完成行为日记的参与者中有4名在基线期和信号评估期之间发脾气行为可靠减少。
本试点研究范围之外，未设立使用护理人员行为日记证据对信号策略进行初步评估的积极对照组。因此，研究结果无法支持当前信号方法的临床疗效。
提供了概念验证证据，即独特提示与随后期望变化的可靠配对可减少相关挑战行为。数据为在进一步评估变化信号方法时采取具体实际步骤的重要性提供了额外支持。
