The system of Behavioral Medicine has been establshed since the beginning of 1980's. The important role of Behavioral Pediatrics would be assured in the field of Behavioral Medicine. Although it is still in the early stage, we admit it holds considerable promise. Due to Russo and Varni, Behavioral Pediatrics is interdiciprinary in nature, being firmly rooted in the empirical methodologies, concerned with diseases mechanisms and behavioral interrelationships, and so on. Also three kinds of the specific techniques chiefly used there : 1. Operant and social learning procedures, 2. Cognitive and behavioral self-regulation procedures, and 3. Biofeedback and physiological self-regulation procedures. In this report the author presents his cases, which have been treated from the stand points of view of behavioral orientation. These are completely indentified with the subjects of Behavioral Pediatrics. Firstly the cases of enuresis nocturna have been cured by the modified methods of Kimmel and Azrin's. The original therapeutic way is not suitable at the several points in Japan, so the modified one has been tried on about fifteen hundreds cases until now. Then three cases of encopresis were treated successfully by behavioral approaches, mainly using operant techniques. The third area is anorexia nervosa of children, which has been increasingly reported in Pediatrics. One of the cases treated with parentectomy, operant conditioning techniques, and nasal feeding. The case, however, finally became ameliorates by covert reinforcement technique, which cured eating phobia of the patient. The problems of compliance of asthmatic children are discussed although they are still in the early stage at this clinic and so the cases of school refusal with psychosomatic symptoms are introduced. The patient who complains some psychosomatic symptoms tends to refuse to attend school. Generally speaking, the processes of the cases are complicated and multi-factorial. Lastly biofeedback therapy on tic syndromes is presented and the author believes is it useful when the family therapy is performed at the same time.

View full abstract

Contingency management procedures were used to modify a child's aggressive behaviors in the home. Those behaviors were the physical aggressive behaviors, verbal aggressive behaviors, and the disobedience to mother's instructions. The treatment was carried out with the mother as the therapist after she received the behavioral parent training. Observation was held for an hour, three days a week to record the frequency of the child's aggressive behaviors. The child's physical aggressive and disobedient behaviors were observed to decrease in frequency as a consequence of the time-out and positive reinforcement procedures. The child's verbal aggressive behaviors, treated with the extinction did not show the significant change. It was concluded that the intervention with both time-out and positive reinforcement is an effective means for treating the physical aggressive behaviors in the home.

View full abstract

The present study closely and multilaterally examined the effect of a strategy "watching self-managed comfortable slides" on pain control, taking individual differences of perceiving pain into consideration. Undergraduate male students were asked to immerse their dominant hands in the cold water, watching the comfortable slides which the subject himself managed (the experimental condition), or watching no such slides (the control condition). The major indices used to compare the effects of these two conditions were tolerance time, magnitude estimates (pain strength perceived at each point of time during hand immersion), and subjective ratings on the effectiveness of the strategy or no strategy. The results showed that the subjects were more successful in pain control under the experimental condition than under the control one in every major index, indicating that the strategy "watching self-managed comfortable slides" is extremely effective in pain control. This result was supported by the analysis in which individual differences of perceiving pain was taken into consideration. Future studies are expected to focus on exploring the intra individual factors which provide for these individual differences.

View full abstract

The purpose of the present study was to investigate the relationship between anxiety responses and performance level on the situation of musical performance anxiety in piano testing. HR was measured as a physiological index of anxiety and ratings of subjective tension as psychological one. Main findings were as follows. (1) As results of factor analysis, 2 factors in HR and 1 factor in tension ratings were extracted as the time sequential pattern of anxiety. The second factor in HR was similar to Epstein (1967)'s time sequential pattern of net anxiety. (2) Multiple regression analysis, using anxiety indices and amount of practice as predictores, indicated that objective performance level was significantly related with patterns of HR and tension. Subjective performance level rated by subject, on the other hand, related with tension level and practice. These findings suggest that the inhibitory process of anxiety, observed in the second factor in HR, could be considered as a important factor for the good objective performance.

View full abstract

Self-monitoring technique was used for eliminating tics and obsessive behavior together with negative practice. The treatment processes of four patients were reported ; there were three primary school boys and one adult lady. These behavior problems were an obsession of stepping a cover of a manhole on the road, a head shaking, voicing "kun, kun" in the class room and a head shaking from left to right of the lady which had been continued for a period of about ten years. Behavior modifications of these tics and an obsessive behavior had been continued till decreasing about 0. The effective of the self-monitoring technique was not cleary concluded because of using with other methods ; negative practice, autogenic training or medication. As Thoresen and Mahoney (1974) had suggested before, it is essential to use together with other methods in order that self-monitoring is utilized effectively. Nevertheless, the author postulated from the treatment of the four cases that the large function of self-monitoring is "awareness" for abnormal behaviors and leads extinction because the response loop of these behaviors will be able to be broken down.

View full abstract

In a 45-bed psychiatric closed ward, 168 schizophrenic patients were involved in 2-year token economy procedures. The target behaviors of token economy procedures were (1) to get up before 7 o'clock in the morning, change clothes and put one's bedclothes into a closet, (2) to set meals on the tables and (3) to rake a garden. In this study, A・B・C・A・C・A・C・D・A・C・E・A design was used, A: baseline phase, B: social reinforcement phase, C: immediate reinforcement phase, D: intermittent reinforcement phase, E: delayed reinforcement phase. Results were as follows. 1. Target behaviors (1) (a) When the baseline levels of the target behaviors were above 80%, token economy procedures were not effective in improving the target behaviors. (b) When the baseline levels were between 80% and 30%, token economy procedures were effective to some extent, but some kinds of reinforcement systems were needed to maintain the improvement of the target behaviors. (c) When the baseline levels were under 30%, token economy procedures were remarkably effective in improving the target behaviors. (d) When the delayed reinforcement phase followed after the immediate reinforcement phase, the target behaviors improved significantly. (e) In the reinforcement phase, patients whose involvement in token economy started from the reinforcement phase improved rapidly, compared with patients who were involved from the first baseline phase. 2. Target behavior (2) (a) Only when the baseline level was 0%, token economy procedures were slightly effective. (b) When the delayed reinforcement phase followed after the immediate reinforcement phase, the target behavior improved slightly. (c) In the reinforcement phase, patients whose involvement in token economy started form the reinforcement phase improved more than patients who were involved from the first baseline phase. 3. Target behavior (3) Token economy procedures were remarkably effective in improving the target behavior, but the length of this experiment was too short to draw any conclusions. 4. In the early stage of token economy procedures, patients who had saved many tokens performed many of the target behaviors, but in the latter stage, patients who had saved many tokens did not perform many of the target behaviors. 5. While the target behaviors (1) improved, the assessment methods (Psychiatric Evaluation Scale and Behavior Rating Scale) showed no improvement. 6. When the effectiveness of token economy procedures was investigated, the "token bound" which Woods et al described was important, and the "token bound" could be divided into 3 types based upon the comparison between the levels of the target behaviors in the first baseline phase, the reinforcement phase and the second baseline phase. (a) Type-1. When the levels in the first baseline phase were high, the levels in the first baseline phase and the reinforcement phase were higher than the second baseline phase (almost the same case Woods et al described). In this case, token economy procedures would not be useful. (b) Type-2. When the levels in the first baseline phase were intermediate, the levels in the reinforcement phase were higher than the first and the second baseline phases, and levels in the first and the second baseline phases were alnost the same. In this case, some kinds of reinforcement systems would be needed to maintain the improvement of the target behaviors. (c) Type-3. When the levels in the first baseline phase were low, the levels in the reinforcement phase were higher than the first and the second baseline phases, and the levels in the second baseline phase were higher than the first baseline phase. In this case,token bound" would occur only on a small scale, and thus, token economy procedures would be useful.

View full abstract