David Leach

The aim of this study was to examine parent–youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample.

The sample comprised 619 parent-youth dyads of youth (8–18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports.
On the whole, parent–youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48–0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07–0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents.

Results support the utility of parent–youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.

To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13–18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8–18 years; 94% female). Significant differences were found between the groups. Children were more commonly male (p < .001), had lower eating pathology scores (p < .001), were less likely to binge eat (p = .02), purge (p < .001) or exercise for shape and weight control (p < .001), and lost weight at a faster rate than adolescents (p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders (p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise (p > .05). The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.

Behavioural Activation (BA) therapy is a stand-alone evidence-based treatment for depression and also is being applied to anxiety with promising outcomes. Essentially, BA involves structured therapy aimed at increasing the amount of activity in a person's daily life, so that he or she comes into contact with sources of positive reinforcement for clinically healthy behaviours. Originally, contemporary BA was developed as a behaviour therapy treatment condition in a study that compared BA to Cognitive Behavioural Therapy (CBT). Over time, many variants of BA have appeared in the published literature, which included techniques that might be viewed as being incompatible with the original intended treatment model and more similar to generic forms of CBT. The purpose of this article is to provide researchers and practitioners with a description of what we consider to be the distinctive and essential elements of BA therapy.

This report describes three single-case experimental evaluations of Behavioral Activation Treatment of Anxiety (BATA) applied with a 51-year-old male, a 62-year-old female, and a 53-year-old female, each of whom met DSM-IV criteria for anxiety. Each case was a clinical replication of an initial trial of BATA reported in Turner and Leach (2009). Treatment was delivered in twelve weekly 60-minute individual sessions and evaluated using an A-B-C phase change with repeated measurement design. Decreased scores in self-reported anxiety were obtained in each case and the improvements were maintained during a 3-month no treatment maintenance phase. Compared to baseline, each participant also recorded increases in activity levels in some key life areas during the treatment phase. These preliminary findings suggest that increased activation in functionally positive areas is associated with reported decreases in anxiety and that BATA could be an effective stand-alone treatment for anxiety in adults.

A 64-year-old male who met criteria for social and generalised anxiety was treated using a brief behavioural activation (BA) approach. The intervention was delivered in twelve weekly 60-minute individual sessions. The effects of the intervention were assessed using a simple A-B-C phase change with repeated measurement design. Change in reported anxiety was recorded across phases. Decreased scores in self-reported anxiety measures were obtained and significant clinical improvement was maintained during a 4-month no treatment maintenance phase. This preliminary investigation suggests BA could be an efficient and effective treatment for anxiety and that replications are warranted.

We examine the current definition of ADHD and its subtypes and the diagnostic procedure described in the DSM-IV. The use of parent and teacher reports and behaviour rating scales in the diagnostic process is also evaluated. The value of more objective data sources, such as direct observations, simulated environments, and continuous performance tests is highlighted. We also describe the measurement of the three behavioural domains of ADHD – Inattention, Hyperactivity and Impulsivity – according to current theory and research. We suggest that greater attention to this literature will help the development of comprehensive, standardised performance tests that add precision to the assessment and diagnosis of ADHD and the ADHD construct itself.

In this paper, the authors describe the concept of fluency and its utility in instructional programming and in the assessment of educational outcomes. Fluency describes competence performance that is characterised by the smooth and effortless combination of accuracy and speed. It depicts a standard of true mastery that bridges the gap between simple acquisition of skills and proficient, useful, generalisable performance. Thus, current operational definitions of fluency incorporate a set of performance generalisation outcomes, namely retention, endurance, stability, application and adduction of newly acquired skills. The paper emphasises how these outcome are characteristic of strong, stable adaptable and proficient performance. Fluency involves a high degree of automaticity in response to specified stimuli. That is, the speed of rate of correct responding is the focus of fluency-based instruction. The authors examine how fluency is dependent on building high rate of accurate performance and describe techniques that facilitate such increases in response rates in the context of teaching basis educational skills. The concepts of stimulus control, repeated practice, accurate feedback and reinforcement are critical in this context. The paper illustrates how fluency is an additional dimension of behaviour beyond performance characteristics that are satisfied by simple measures of accuracy. The advantages of rate measure over traditional percentage correct measures are outlined. The paper considers the history of fluency research, the evolution of the concept of research theory and its current status in education, current regenerated interest and renewed attention to fluency in educational literature.

Three primary school teachers attended a half‐day, in‐service training workshop which targeted instructional and managerial behaviours identified as being functionally related to students’ academic engaged behaviours in class. Following the workshop, daily observations showed only temporary changes in the teachers’ and their students’ behaviours with trends back towards baseline measures. After this period of ‘no feedback’, three conditions of in‐class performance feedback were introduced in different sequences to each teacher: outcome feedback (based on measures of a sample of their students’ academic engaged behaviour during lessons), process feedback (based on measures of the teachers’ own instructional behaviours), and a combination of both outcome and process feedback. A time‐series, multiple baseline across subjects design was employed which allowed comparison of measures of teachers’ and students’ behaviours during the immediate post‐workshop period and during periods of the three types of feedback. The results showed that the introduction of performance feedback had the immediate (and cumulative) effect of increasing the behaviours targeted in the workshop to high rates that were maintained even when feedback was withdrawn. There were, however, no differences in the comparative efficacy of outcome, process or outcome/process combination effects. The study builds upon existing research which has shown performance feedback to be an essential component of effective professional development and staff training packages that target workplace behaviour change. It also adds to the limited research that has examined the efficacy of different types of performance feedback and suggests other variables, such as who presents the feedback, may be important.

Between 10% and 25% of children in Australian schools have significant difficulty in mastering basic educational skills. Failure to achieve 'tool' competencies in literacy (and numeracy) expected for independent adult functioning can have cumulatively negative consequences for individuals and their communities. The contribution of behavioural approaches to the instruction in basic literacy skills in schools is outlined. Empirical evidence of their effectiveness is presented and two of the most comprehensive (and most successful) models are described: the Morningside model of generative instruction and direct instruction. Despite strong research support, however, behavioural approaches have not been widely adopted in general education. It is suggested that the main barriers to their adoption are the currently dominant paradigms of structuralism and constructivism, neither of which have translated into effective teaching practices for children most at risk of failure. Constructivist epistemology, in particular, is seen as oppositional to behaviour-based instruction and scientist-practitioner intervention, and its disregard for empiricism is cause for concern that ineffective practices will be maintained. It is concluded that behaviour-based practitioners (and researchers) need to become more effectively involved in system-level change strategies if they are to make an impact on the wider problems of educational failure.

The goal of the Murdoch Early Intervention Program was to replicate the intensive early intervention program designed by O. I. Lovaas for 24 to 48 mo old children with severe developmental disability and autism. This paper describes the objectives, methods, and the results as of 24 mo. Four of 9 experimental children with autism have shown signs of approaching normal levels of functioning whereas 1 of 5 control children without autism has made significant progress. Improvements in the other Ss are rated as moderate to minimal.