رفتاردرمانی و صفات غیرعاطفی سنگدلانه: بررسی اثر یک مطالعه مقدماتی بررسی اصلاح رفتاری احتیاطی بر رفتار کودک

Abstract The conduct problems of children with callous-unemotional (CU) traits (i.e., lack of empathy, lack of guilt/lack of caring behaviors) are particularly resistant to current behavioral interventions, and it is possible that differential sensitivities to punishment and reward may underlie this resistance. Children with conduct problems and CU (CPCU) are less responsive to behavioral punishment techniques (e.g., time-out), whereas reward techniques (e.g., earning points for prizes or activities) are effective for reducing conduct problems. This study examined the efficacy of modified behavioral interventions, which de-emphasized punishment (Condition B) and emphasized reward techniques (Condition C), compared with a standard behavioral intervention (Condition A). Interventions were delivered through a summer treatment program over 7 weeks with an A-B-A-C-A-BC-A design to a group of 11 children (7–11 years; 91% male). All children were diagnosed with either oppositional defiant disorder or conduct disorder, in addition to attention-deficit hyperactivity disorder. Results revealed the best treatment response occurred during the low-punishment condition, with rates of negative behavior (e.g., aggression, teasing, stealing) increasing over the 7 weeks. However, there was substantial individual variability in treatment response, and several children demonstrated improvement during the modified intervention conditions. Future research is necessary to disentangle treatment effects from order effects, and implications of group treatment of CPCU children (i.e., deviancy training) are discussed.

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Results Sports Activities Group Effects Using repeated measures one-way ANOVA, there was a significant main effect of condition on levels of negative behavior during activities, F(2, 16) = 5.28, p = .02, ηp2 = .37. The assumption of sphericity was violated, therefore, degrees of freedom were adjusted. Examination of means (see Table 2) and post hoc multiple comparisons showed that negative behavior was highest during the combined condition, with rates of negative behavior that were significantly higher than any other condition (ps < .03; Hedges’s g for combined condition with standard12 = .69, low punishment = .92, high reward = .92, standard 34 = .41). The standard34 and high-reward conditions followed, and the standard34 condition had significantly higher rates of negative behavior than the standard12 condition (p = .01, Hedges’s g = .33), and marginally significantly higher than the low-punishment condition (p = .09, Hedges’s g = .63). However, levels of negative behavior during the high-reward condition were not significantly different from any other condition excluding the combined condition. Finally, negative behavior was lowest during the low-punishment and standard12 conditions, which did not significantly differ from each other. Individual Differences Descriptive analyses of individual differences in response to treatment (see Figure. 1) suggested a number of interesting patterns. First, a handful of children demonstrated a similar response pattern to the group-level pattern, albeit at varying levels of negative behavior severity (i.e., Participants 1, 4, and 10). On the other hand, some children responded well to both low punishment and high reward in comparison with the standard treatment conditions (i.e., Participants 6, 8, and 9). Finally, some children demonstrated consistently low levels of negative behavior throughout the summer (i.e., Participants 2, 5, 7, and 11), whereas others demonstrated consistently high levels of negative behavior throughout the summer (e.g., Participant 3 [absent during low punishment due to physical injury that occurred outside of treatment]). Full-size image (27 K) Figure 1. Average daily rate of negative behavior during activities for each participant. Note. LP = low punishment, HR = high reward, LPHR = combined, S12 = standard12, and S34 = standard34. Figure options Time-Out Group Effects Repeated measures one-way ANOVA revealed a significant main effect of condition on levels of negative behavior, F(4, 20) = 8.68, p < .001, ηp2 = .64. Examination of means (see Table 2) and post hoc multiple comparisons showed that time-out data largely paralleled the sports activities data. First, the combined condition had significantly higher rates of negative behavior compared with any other condition (ps < .04; Hedges’s g for combined condition with standard12 = 1.35, low punishment = 1.44, high reward = .84), excluding standard34. The second-highest rates of negative behavior occurred during the standard34 condition. Negative behavior during the standard34 condition was significantly higher than the standard12 and low-punishment conditions (ps < .02; Hedges’s g for standard 34 with: standard12 = 1.21, low punishment = 1.35), and marginally significantly higher than the high-reward condition (p = .09, Hedges’s g = .57). Negative behavior during the high-reward condition was significantly higher than during the standard12 condition (p = .04, Hedges’s g = .97), but did not significantly differ from rates of negative behavior during the low-punishment condition. Finally, the lowest rates of negative behavior occurred during the standard12 and low-punishment conditions, both of which were close to zero and did not significantly differ. Individual differences Individual differences during time-out also paralleled individual differences during sports activities (see Figure. 2). Again, Participants 1 and 10 demonstrated a similar response pattern as group-level performance. However, Participant 4 demonstrated relatively uniform and high levels of negative behavior across the high-reward, combined, and standard34 conditions. Further similarities between time-out and activity performance were noted among children with low base rates of negative behavior during activities, who were rarely in time-out, and never demonstrated any negative behaviors at any point during their time-outs. Interestingly, there was no consistent response pattern within time-out among children who responded well to both low-punishment and high-reward conditions during activities (i.e., Participants 6, 8, and 9). Only Participant 9 replicated his or her activity response pattern during time-out, whereas Participant 6 performed relatively poorly during the high-reward condition and Participant 8 performed relatively poorly during the low-punishment condition on time-out measures. Finally, Participant 3 maintained relatively high levels of negative behavior during time-out across all conditions for which this child was present. Full-size image (24 K) Figure 2. Average daily rate of negative behavior per minute of time-out for each participant.