The Use of Differential Reinforcement and Fading to Increase Time Away from a Caregiver in a Child with Separation Anxiety Disorder.

Abstract The use of differential reinforcement of other behavior (DRO) and fading of time away from caregivers in an 11-year old boy with Separation Anxiety Disorder (SAD) is illustrated. During baseline, the participant exhibited emotional behavior (i.e., crying, whining, asking to contact parents) as soon as his caregiver left the therapy room. During intervention, the participant was given access to preferred items contingent upon the absence of emotional behavior during time away from his mother. A changing criterion design was used to evaluate intervention effects. Results indicated that the intervention was successful in increasing the amount of time the child was able to be away from his mother without exhibiting emotional behavior. DESCRIPTORS: differential reinforcement of other behavior (DRO), emotional behavior, fading, separation anxiety disorder. ********** When child protests (i.e., cries, whines, whimpers, etc.) upon separation from a parent or other caregiver are excessive and persist over time, Separation Anxiety Disorder (SAD) may be diagnosed. SAD is characterized by an abnormally heightened fear response to real or imagined separation from parents and / or other caregivers. Other criteria for a diagnosis include a duration of the disturbance of at least 4 weeks, onset before age 18, and the presence of clinically significant distress or impairment in social, academic, or other areas of functioning (American Psychiatric Association, 1994). The activities of children with separation anxiety disorder can be severely limited because these children often insist on remaining in close physical proximity to a caregiver. In addition, this disorder may make it difficult for parents and other caregivers to enjoy their own independent activities due to constant worry about their children when separated. Reports of the prevalence of SAD range from 2.7% to 4.5% in children and young adolescents (Masi, Mucci, & Millepiedi, 2001). There is also some evidence that children with SAD are disproportionately diagnosed with a variety of anxiety disorders in adulthood. In one longitudinal prevalence study, 83% of participants who received a diagnosis of juvenile separation anxiety disorder also received a diagnosis of an anxiety and / or depressive disorder as an adult (Silove, Manicavasagar, & Drobny, 2002). Although many mental health professionals view SAD as an unlearned "disorder of attachment," research has suggested that parents and caregivers may inadvertently teach their children to behave in this manner by delaying their departure, returning, or reasoning with their child contingent upon protests (Gewirtz & Pelaez-Nogueras, 1991; Gewirtz & Pelaez-Nogueras, 1992). Gewirtz & Pelaez-Nogueras (1992) experimentally demonstrated that contingent attention increased protesting behaviors in young children. They further demonstrated that noncontingent attention delivered by parents while they were leaving decreased separation protests in these same children. The treatment of SAD has taken two general approaches: pharmacological and behavioral. Pharmacological treatment has included the use of antidepressants such as imipramine (Klein, Koplewicz, & Kanner, 1992) and fluvoxamine (Pine, Walkup, & Greenhill, 2001). Even though some studies have shown these drugs to be effective (Gittleman-Klein, & Klein, 1971; Pine et al., 2001), pharmacotherapy is generally suggested for use after behavior therapies have failed or in combination with behavioral techniques, although patients are probably more likely to receive drug treatment alone than any other form of treatment (Masi et al., 2001). Interestingly, there have been reports of the antipsychotic medication resperidone actually increasing symptoms of SAD in some children (Hanna, Fluent, & Fischer, 1999). Although there have been some uncontrolled case studies of the successful behavioral or psychosocial treatment of SAD (e. …