A variety of treatment approaches have been used to manage tic symptoms in Tourette syndrome and other tic disorders. Pharmacological interventions remain the most common approach, but in the past 3 decades, various nonpharmacological treatment options have emerged including:(1) massed practice,(2) relaxation training,(3) self-monitoring,(4) function-based/contingency management procedures,(5) habit reversal training,(6) exposure and response prevention, and (7) cognitive behavior therapy. Each of these procedures is described along with the evidence reflecting its efficacy and usefulness. A synthesis of the findings and implications is provided, including directions and recommendations for future treatment and research.

This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.

The present article outlines the potential benefits to the treatment of stuttering, if altered auditory feedback methods, especially frequency-shifted feedback, were to be combined with behaviour modification techniques. A potential framework for understanding the integration of these approaches is presented in the context of assessing the limitations of each approach in isolation. A number of suggestions concerning the use of partial prompting and partial reinforcement, drawn from the animal conditioning literature, that may promote the efficacy of such a treatment are also made.

Although self-injurious behavior is present in all subtypes of hereditary sensory and autonomic neuropathy, the literature has not sufficiently addressed the issue of treatment of self-injury in this population. Therefore, the purpose of the current case study was to describe a method for assessing and treating self-injurious behavior associated with hereditary sensory and autonomic neuropathies. This study was conducted with an 11-year-old boy diagnosed with hereditary sensory and autonomic neuropathy type II admitted to an inpatient behavioral unit over a 4-month period. A simplified version of a habit reversal treatment was used, consisting of awareness training, self-monitoring, competing responses, and social support. Treatment resulted in a 98% reduction in the rate of self-injurious behavior relative to pretreatment baseline rates. This case study illustrates that behavioral interventions may be a viable option for treating self-injury secondary to hereditary sensory and autonomic neuropathies.

BACKGROUND Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children. OBJECTIVES To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966-2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On-line: National Research Register, Meta-register of Controlled Trials, ZETOC alerts, SIGLE (August 2005). SELECTION CRITERIA RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema. DATA COLLECTION AND ANALYSIS Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis. MAIN RESULTS Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video-based education more effective in improving severity than direct education and the control (discussion)(p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042). AUTHORS' CONCLUSIONS A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.

Exposure keratopathy, including that which occurs following laser assisted keratomileusis, appears to be associated with incomplete blinking. Incomplete blinking may contribute to the signs and symptoms of lid wiper epitheliopathy. In addition, precipitation of contact lens surface deposits and other contact lens surface drying phenomena, appear to be accelerated by incomplete blinking. For the inferior cornea or contact lens surface an incomplete blink approximately doubles the interblink interval and tear evaporation time, becoming even longer as blink rates reduce for computer and reading tasks. Inadequate aqueous, mucous and lipid distribution, as well as tear thinning over the exposed ocular or contact lens surface, may further increase the rate and significance of tear break-up and evaporation following an incomplete blink. Increased tear osmolarity that is associated with accelerated tear evaporation may also contribute to tissue changes and symptoms. Behaviour modification and habit reversal methods can be employed in the provision of blink efficiency exercises that are used to overcome incomplete blinking habits, with the potential to improve lipid, mucous and aqueous distribution so that exposure keratopathy, lid wiper epitheliopathy, and any associated symptoms are alleviated and/or prevented. Similarly, improved blink efficiency may help maintain lens surface condition and alleviate dryness symptoms for contact lens wearers. Lubricant drop instillation that is combined with blink efficiency exercises may increase the therapeutic benefit to corneal, conjunctival and lid wiper epithelium, as well as improving contact lens performance. Conditions of drop instillation, that reduce reflex blinking and tearing, may increase drop contact time and therapeutic benefit.

It is well established that Tourette syndrome has a neurobiologic origin. Although pharmacotherapy is the most commonly prescribed intervention, there is considerable evidence to support the use of behavior therapy, specifically habit reversal training, as an alternative or adjunct treatment for some individuals with Tourette syndrome. Unfortunately, many professionals are unfamiliar with habit reversal training. The purpose of this review is to provide readers with a brief review of empiric studies on habit reversal training, update readers on the current state and future of behavior therapy for Tourette syndrome, and provide resources for those readers interested in additional information.

Much is known about human exposure to workplace hazardous substances by inhalation and from skin contact, but there has been little systematic research into ingestion of hazardous substances used at work. This review attempts to identify whether inadvertent ingestion of hazardous substances is an important route of exposure in the workplace and examines possible methods that could be used to quantify ingestion exposure. A number of papers highlight jobs and substances where inadvertent ingestion may be important, typically through case reports or from a theoretical analysis. These scenarios involve exposure to some metals or metal compounds, pharmaceuticals, pesticides, some infectious agents, unsealed radioactive sources and some high molecular weight allergens. In total we estimate that about 4.5 million workers in the UK could have some regular non-trivial intake of hazardous substances by inadvertent ingestion. A conceptual analysis of inadvertent ingestion exposure highlights the role of hand-to-mouth and object-to-mouth events as the primary exposure processes. Two exposure 'compartments' are defined: the peri-oral area (i.e. the area of skin around the outside of the mouth) and the oral cavity. Several options are highlighted for exposure-related measurements, including peri-oral wipes, saliva samples, mouth-rinse samples, hand-wipes and under-nail scrapings. Further research is necessary to define which measurements may be most informative. Human behaviour has a key role in determining inadvertent ingestion exposure. For example, some people are habitual nail biters or repeatedly touch their mouth, both of which will increase the chance of ingesting contaminants on their hands. The frequency that people touch their face is dependant on the circumstances of their work and probably the degree of psychological stress they are under. A proper understanding of the importance of these factors will help in designing interventions to reduce the risks from ingesting hazardous substances at work. When making inhalation or dermal exposure measurements we recommend that details of personal behaviours should be recorded so that some estimate of ingestion risks can be inferred. It is possible that inadvertent ingestion of hazardous substances at work may become more important as employers put more emphasis on controlling inhalation and dermal exposures. Further research is necessary to ensure that risk reduction strategies for inadvertent ingestion of hazardous substances are appropriate and effective.

The purpose of this study was to compare the effectiveness of habit reversal (HR) to a wait-list control as a treatment for chronic skin picking in adults. Twenty-five adults with a chronic skin-picking problem were randomly assigned to a wait-list control or HR group. At pretreatment, posttreatment, and a 3-month follow-up, self-reported skin picking was assessed, and photographs were taken of the damaged areas and later rated by independent observers. Treatment acceptability data were collected at posttreatment only. Results showed that HR produced a greater decrease in skin picking at posttreatment and follow-up when compared to the wait-list control group. Data from the independent raters confirmed these findings. HR was also viewed as an acceptable intervention by the participants.

One of the most commonly reported and successful behavioral interventions for tic disorders is habit reversal (HR). Several narrative literature reviews have adequately summarized the outcomes of these studies. The purpose of this article was to review studies that used HR to treat tics in terms of their methodological characteristics and rigor. Guidelines developed by the Task Force on Promotion and Dissemination of Psychological Procedures were used to evaluate the state of the literature. From an initial database that included 29 studies, 12 were included in the final analysis. Results indicate that although research has been conducted in this area for almost three decades, the majority of studies contain considerable methodological shortcomings. Based on the Task Force guidelines, the existing literature on the use of HR to treat tics can currently be classified as probably efficacious, and it almost meets the criteria for the well-established classification. Directions for future research are discussed.

This paper reviews the overcorrection literature with a focus on the subject populations, dependent variables, procedural variations and research methodology reflected in overcorrection research. It analyzes overcorrection in terms of its punishment characteristics, and based on this, offers suggestions for the effective use of overcorrection. It raises issues regarding generalization and maintenance and the lack of data supporting claims for an educative value of overcorrection. We conclude that overcorrection can be an effective response suppressing procedure with greater social acceptability than other forms of punishment, but that the staff time involved in its use constitutes a possible drawback. We suggest the need for analytic research to identify overcorrection's critical components and minimal effective duration. Finally, we offer a suggestion for the use of more descriptive and precise terminology with respect to overcorrection procedures.

Prior research has shown that muscle tics can be suppressed by the performance of a competing response contingent on the occurrence of the muscle tics. In an effort to determine whether the topography of the competing response was important to the muscle tic suppressing effects of contingent competing response practice, we evaluated the effects of a competing response that was topographically dissimilar to the muscle tic. Three subjects engaged in dissimilar competing responses contingent on the occurrence of a muscle tic; 2 of these subjects subsequently engaged in similar competing response practice. The results showed a decrease in objective measures of muscle tic frequency with the introduction of dissimilar competing response practice for each subject; subsequent exposure to similar competing response practice for 2 subjects resulted in no additional decrement in the level of muscle tics. These results suggest that the topography of the competing response may not be crucial for the suppression of muscle tics. Discrepancies between the objective measures of muscle tics and self-recorded measures are noted and discussed.

In the present study 26 children with chronic oral-digital habits were randomly assigned to 1 of 3 conditions. Group 1 received habit reversal using a similar competing response. Group 2 received habit reversal using a dissimilar competing response, and Group 3 served as a wait-list control group. Three videotaped observations were taken at pretreatment and again at posttreatment. In addition, social acceptability data were collected on the treatment groups at posttreatment. Results showed that the similar and dissimilar groups were engaging in significantly less oral-digital behavior at posttreatment when compared to the control group. However, the two treatment groups did not differ from each other in terms of treatment gains or acceptability. These results suggest that habit reversal is an effective treatment for oral digital habits in children. In addition, it appears that the competing response does not function as a physically incompatible behavior. Implications of the findings are discussed.

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training;(b) awareness training and self-monitoring;(c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.

In this study the frequency of chewing behavior in a 6-year-old male diagnosed with pica was reduced using a simplified habit reversal procedure. Data were collected on the frequency of chewing behavior, treatment acceptability, parent satisfaction, and social validity of the behavior change. This study represents the first known application of the habit reversal procedure to treat pica-related chewing in a normally intelligent child.

This study examines the prevalence of nervous habits, tics and stuttering in 256 college students, as well as the relationship between these behaviors and self-reported general anxiety and awareness of bodily sensations. Improving on previous studies, this study strengthens the operational definition of a nervous habit by using a more stringent operational definition, giving what is arguably a more valid set of prevalence statistics. Participants were asked to complete self-report measures of general anxiety and somatic awareness. Relationships were found between number of nervous habits and tics that participants endorsed and their self-reported awareness of bodily sensations, as well as between number of habits endorsed and self-reported general anxiety. This article concludes with suggestions for future research in the area of nervous habits and motor tics.

In this study, 44 individual were exposed to three conditions (anxiety, bored, and neutral) while being covertly videotaped. The videotapes were then scored for the occurrence of five classes of habits including hair, face, and object manipulation; object mouthing; and repetitive movement of the limbs. Results showed that hair and face manipulation increased during the anxiety condition, whereas object manipulation increased in the bored condition. The implications of this research are discussed.

Research is reviewed on habit reversal treatment of tics and other nervous habits, and on the components of such treatment. Awareness training and the use of a competing response are found to be its essential components. Studies which evaluate the habit reversal procedure and its variations in the treatment of stuttering are also reviewed.

The response rate of an educably mentally retarded male on a folder assembly task and for two types of self-stimulatory behavior was measured under fixed ratio, variable ratio, and fixed ratio pacing schedules of reinforcement. Higher work rates were maintained by the variable ratio and fixed ratio pacing schedule than by the simple fixed ratio schedule. The rate of self-stimulatory behavior associated with each reinforcement schedule and with a medication termination was also reported.

Two procedures were used to teach behavioral assessment interviewing skills: a training manual and one-to-one instruction that included modeling, rehearsal, and feedback. Two graduate students and two advanced undergraduates were trained with each procedure. Interviewing skills were recorded in simulated assessment interviews conducted by each student across baseline and treatment conditions. Each training procedure was evaluated in a multiple baseline across students design. The results showed that both procedures were effective for training behavioral interviewing skills, with all students reaching a level of 90%-100% correct responding. Finally, a group of experts in behavior analysis rated each interviewing skill as relevant to the conduct of an assessment interview and a group of behavioral clinicians socially validated the outcomes of the two procedures.

Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity failures and the efficacy of behavioral interventions. Avenues for future research are provided.

Past researchers have commented on the role of specifying relevant subject characteristics in determining the generality of experimental findings. Knowledge of subject selection criteria is important in interpreting and replicating research results. Such knowledge, as compared with many other historical and demographic characteristics of the subject, is likely to be related to a procedure's effectiveness. Data indicated that the majority of articles published in the Journal of Applied Behavior Analysis do not provide an adequate description of subject selection criteria. The failure to provide detailed information concerning subject selection criteria can prevent systematic replication of research results. The relatively low cost inclusion of complete descriptions of subject selection criteria would enhance the generality of applied behavior analysis research by facilitating systematic inductive manipulations and replications.

We describe a notation system for diagramming behavioral contingencies. The system is descriptive. Stimulus functions are not represented with special symbols, such as S(R), S(D), or UCS, but are simply described in terms of the relation between behavior and stimulus change, and the resulting outcome. The system is atheoretical, self-explanatory, and easy to use. Our goal is to provide an approach to contingency diagramming for the student that represents directly the exact relations and outcomes involved in operant and respondent processes.

August Dvorak is best known for his development of the Dvorak keyboard. However, Dvorak also adapted and applied many behavioral and scientific management techniques to the field of education. Taken collectively, these techniques are representative of many of the procedures currently used in applied behavior analysis, in general, and especially in precision teaching. The failure to consider Dvorak's instructional methods may explain some of the discrepant findings in studies which compare the efficiency of the Dvorak to the standard keyboard. This article presents a brief background on the development of the standard (QWERTY) and Dvorak keyboards, describes parallels between Dvorak's teaching procedures and those used in precision teaching, reviews some of the comparative research on the Dvorak keyboard, and suggests some implications for further research in applying the principles of behavior analysis.

There is accumulating evidence from different methodological approaches that the placebo effect is a neurobiological phenomenon. Behavioral, psychophysiological, and neuroimaging results have largely contributed to accepting the placebo response as real. A major aspect of recent and future advances in placebo research is to demonstrate linkages between behavior, brain, and bodily responses. This article provides an overview of the processes involved in the formation of placebo responses by combining research findings from behavioral, psychophysiological, and neuroimaging methods. The integration of these different methodological approaches is a key objective, motivating our scientific pursuits toward a placebo research that can inform and guide important future scientific knowledge.

It is estimated that 1 in 10 adults aged 65 years and older have been diagnosed with dementia, which is associated with numerous behavioral excesses and deficits. Despite the publication of a special section of the Journal of Applied Behavior Analysis (JABA) on behavioral gerontology (Iwata, 1986), there continues to be a paucity of behavior-analytic research with this population. This review compares the research published before and after the behavioral gerontology special section and evaluates the most recently published aging articles in JABA.

We examined articles in the Journal of Applied Behavior Analysis in which results of functional analyses indicated that problem behavior was maintained by multiple sources of reinforcement. Data for 88 (16.9%) of 521 subjects reported in 168 studies met the criteria for multiple control. Data for 11 subjects (2.1%) involved a single response topography, whereas data for 77 subjects involved multiple, collapsed response topographies (14.8% of the total [521 cases] or 87.5% of the multiple control cases), suggesting that when multiple control is observed, it often may be a by-product of response aggregation during assessment.

We conducted a systematic analysis of studies that involved the treatment of rumination and operant vomiting in individuals with developmental disabilities. A total of 21 studies involving a combined 32 participants were identified and analyzed in terms of (a) participant characteristics,(b) dependent variables,(c) intervention procedures,(d) functional assessment procedures and results,(e) intervention outcomes, and (f) certainty of evidence. In comparison to previous reviews on rumination and operant vomiting, this review identified fewer studies involving punishment-based interventions and an increase in function-based reinforcement interventions. Preliminary guidelines for practitioners faced with assessing and treating these behaviors are offered and directions for future research are discussed.

This review summarizes the 6 studies with nonhuman animal subjects that have appeared in the Journal of Applied Behavior Analysis and offers suggestions for future research in this area. Two of the reviewed articles described translational research in which pigeons were used to illustrate and examine behavioral phenomena of applied significance (say-do correspondence and fluency), 3 described interventions that changed animals' behavior (self-injury by a baboon, feces throwing and spitting by a chimpanzee, and unsafe trailer entry by horses) in ways that benefited the animals and the people in charge of them, and 1 described the use of trained rats that performed a service to humans (land-mine detection). We suggest that each of these general research areas merits further attention and that the Journal of Applied Behavior Analysis is an appropriate outlet for some of these publications.

Every article on stimulus equivalence or derived stimulus relations published in the Journal of Applied Behavior Analysis was evaluated in terms of characteristics that are relevant to the development of applied technologies: the type of participants, settings, procedure (automated vs. tabletop), stimuli, and stimulus sensory modality; types of relations targeted and emergent skills demonstrated by participants; and presence versus absence of evaluation of generalization and maintenance. In most respects, published reports suggested the possibility of applied technologies but left the difficult work of technology development to future investigations, suggestions for which are provided.