Although Van Houten and colleagues (1988a, 1988b) generated two separate publications with identical content under the title “The Right to Effective Treatment,” five other rights were included. To determine the impact on research, we measured an objective outcome—the number of citations since publication in both The Behavior Analyst and the Journal of Applied Behavior Analysis. We presented citations for each year from 1989 until December 2016, some 28 years later. There appears to be an increasing trend in the citation of Van Houten et al. (1988a; 1988b) over the years. Finally, to determine the impact of the policy on practice, we attempted to compare the Professional and Ethical Compliance Code for Behavior Analysts (the Code; Behavior Analyst Certification Board, 2017) with the six rights in Van Houten et al. (1988a; 1988b). The Code clearly covers all six rights. We then proposed several recommendations and a checklist to be used in clinical settings.

Combined use of chloropicrin (Pic) and 1,3-dicloropropene (1,3-D) is as effective as methyl bromide (MB) at controlling soilborne diseases in many trials and commercial uses. However, Pic and 1,3-D are both highly volatile and may pose strong exposure risks to humans and the environment. A gelatin capsule formulation containing Pic and 1,3-D has been developed to reduce exposure risks to workers and bystanders and improved application safety. We conducted two experiments in tomato and cucumber greenhouses located in Beijing and Qingdao, China, to study the efficacy of Pic plus 1,3-D gelatin capsules applied at different dosages and soil depths. Results indicated that both injection and gelatin capsules of Pic plus 1,3-D provided good control of soil nematodes and reduced disease index of Fusarium wilt and root-knot nematode. Plant yield of tomato and cucumber treated with gelatin capsules was similar to MB treatment. Based on our results, gelatin capsules applied at a soil depth of 15 cm provided better control of soilborne diseases and led to higher fruit yield compared to an application depth of 5 cm. In conclusion, a gelatin capsule of Pic plus 1,3-D is a promising and novel formulation, which not only shows good efficacy in controlling soilborne diseases, but also reduces potential exposure risks of fumigants.

This book provides a comprehensive overview of the clinical phenomenon of pica. It focuses specifically on the disorder as it presents in children, adolescents, and adults with autism spectrum disorde

Functional analysis was originally developed for the assessment of self-injury and has readily been extended with some modification, to functional assessment of pica. The most common modifications include the use of so-called baited environments, in which safe pica items are available, and sometimes modifications to ensure safety, such as blocking consumption of pica items. Almost all functional analyses of pica have identified the function to be automatic positive reinforcement. Some functional analyses have identified specific aspects of item texture that affects the rate of pica. Specific variables that may be important in the functional analysis of pica include the presence of alternate food or leisure items, response effort for pica and the alternate behavior, various parameters of response blocking such as blocking early or late in the response chain, and stimulus control, such as the visibility of the pica item. Because pica is almost always maintained by automatic positive reinforcement, function-based treatment is challenging, as reflected in the relatively common use of positive punishment procedures, such as response blocking, in the research literature.

This chapter briefly reviews the often used crisis intervention approaches for the temporary prevention of pica. These include one-to-one staffing, continuous restraint, and one-to-one staffing combined with continuous restraint. These temporary methods are, if used alone, inadequate. The chapter then presents a successful clinical management program implemented during a period of nine (9) years for forty-one (41) individuals with developmental disabilities and pica. During this long-term period, these individuals were protected from harm. No surgeries were required during the period of 9 years, a reduction to zero from a high of 9 surgeries for the removal of foreign objects during the 9 years prior to intervention. Continuous restraint was eliminated. The use of functional behavior assessment, pica risk assessments, rights protections, hierarchical behavior intervention plans, and an environmental clinical management system (e.g., supervisory monitoring and feedback, pica-safe classrooms and living areas, policies on pica safety procedures, and staff training on pica prevention) were responsible for these outcomes. However, this report is largely descriptive and retrospective and thus has major methodological limitations. Nevertheless, we believe that practitioners may benefit by considering that individual behavior plans require long-term intervention and a program delivery system for carrying out the plans over all waking hours.

Pica refers to the problematic consumption of non-nutritive substances. It can be distinguished from developmentally typical mouthing, problematic mouthing of objects, and hand mouthing because it involves consumption rather than mouthing of non-nutritive substances. Pica should be diagnosed accurately and promptly to ensure access to treatment. Different forms of pica have been recognized for hundreds of years. These include culture-specific practices, such as ritualistic eating of dirt. Pica is also observed in pregnancy and biomedical disorders, such as anemia and sickle cell disease, cases of lead poisoning, and nutritional deficiencies, such as iron and zinc deficiency. It is most commonly recognized as problematic in individuals with developmental and psychiatric disorders. Pica is most commonly highly problematic in individuals with severe and profound intellectual disabilities (ID). Pica is also observed in animals, especially those with nutritional deficiencies. The risks of pica vary from mild and transient to life-threatening and fatal.

This chapter begins by distinguishing radical behaviorism from other approaches to assessment. Behavioral assessment is characterized by identification of current environmental stimuli that control behavior including its establishing operations, discriminative stimuli, and consequences. Behavioral assessment has a long history and has been applied effectively to assess pica. The chapter describes treatment goals, ethics of treatment and assessment and risk assessment when working with pica. Finally, the chapter illustrates common behavioral treatments. These include environmental enrichment, skills training, differential reinforcement, over correction, verbal reprimands, restraint, visual screening, habit reversal, negative practice, response blocking various aversive stimuli, overcorrection, and pica safe materials.

The last 30 years have seen a growing body of outcome studies of behavioral treatment of pica. This is reflected in case series, including one from an inpatient treatment unit and one from a regional clinic. Additionally, a series of systematic reviews and meta-analyses documents the growing outcome literature on behavioral treatment of pica. This has allowed some to conclude that behavioral treatments generally are now an evidence-based practice, and has also allowed some differentiation of the effectiveness between the relative effectiveness of different treatments, such as environmental enrichment, and other treatments.

For the last 25 years, the only empirically determined system to evaluate the content of written behavior analysis plans was developed by Vollmer et al. (1992). For the current study, the content of that earlier system was revised by the first author and submitted to 48 members of the editorial board of the Journal of Applied Behavior Analysis and seven (7) other acknowledged experts on the editorial boards of Behavioral Interventions and Research in Developmental Disabilities. Of 55 recipients, 36 responded. The thirty-six (36) respondents rated each of 28 items from essential to non-essential using a five-point Likert scale. After reviewing the expert panel members’ evaluations, we reduced the 28 items to 20 essential components of written behavior treatment plans. The implications of the results were discussed.

Pica is a dangerous form of self-injurious behavior that occurs in people with developmental disabilities who are institutionalized. Studies also indicate that pica has led to the death of people with developmental disabilities. While a number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment, few of these studies incorporated strategies for generalization and maintenance outside of brief sessions. A second limitation of current research is that some studies reduced pica substantially, but pica responses still occurred at rates that are problematic in terms of prevention of adverse consequences, which leaves practitioners with the task of further decreasing pica to protect people exhibiting pica from harm. We make recommendations for assessment, treatment, and prevention of pica for practitioners. These recommendations are based on two extensive reviews of the literature and our extensive experience as practitioners in the treatment of pica. Our hope is that administrators, professionals and practitioners will consider our guidelines and recommendations as they attempt to protect people with pica and developmental disabilities from harm by developing standards for assessment, treatment and prevention for this difficult-to-treat population. Our hope is that children with pica will receive early intervention to prevent pica from developing into life-threatening behavior.

We used an organizational behavior management (OBM) approach to increase behavior intervention plans and decrease the use of mechanical restraint. First, recipients were tracked as a member of the priority group if they engaged in frequent self-injurious behavior or physical aggression toward others and/or if they had been placed in mechanical restraint as a result of the problem behaviors. Second, a behavior data monitoring and feedback system was put in place. Third, organizational contingencies for the use of mechanical restraint or the occurrence of frequent self-injurious behavior or physical aggression toward others were initiated. Over the course of 17 months, behavior intervention plans were more than doubled to 124 and mechanical restraints decreased by almost 80%. This study represents the first to use an organizational behavior management (OBM) to reduce restraint with people who have intellectual disabilities.

This paper provides a brief overview of the most recent research (1999–2009) on restraint reduction and elimination efforts in the literature and also examines the characteristics of restraint along with the risks and benefits. Some earlier papers were included in this review because of their importance to the topic. The results of this literature review are discussed in terms of implications for practitioners and researchers.

Background There is little research on the safety of the various types of restraint commonly used with individuals with intellectual disabilities who exhibit severely aggressive or self‐injurious behaviour.Method This study analysed the use of restraint with 209 individuals with intellectual disabilities over a 12‐month period.Results Planned restraint, the use of restraint as a component of a behaviour treatment programme (i.e. planned personal or planned mechanical restraint) was safer than crisis‐intervention restraint (emergency personal or emergency mechanical). The overall rate of injuries during restraint was 0.46 injuries per hundred restraints. Restraint was applied 99.54% of the time without injury.Conclusion Restraint was relatively safe and safer than reported in one other study. Planned restraint was safer than emergency restraint. The additional training and programme development associated with planned restraint may have contributed to the greater safety of planned restraint. Due to limited empirical data, restraint safety has yet to be established and this study suggests that restraint should be decreased and closely monitored.

Background Pica is a very dangerous form of self‐injurious behaviour because one occurrence can be lethal. Dealing successfully with dangerous pica in a large institution requires a high level of administrative support. It cannot be relegated to each psychologist to write a programme. A written behaviour programme is only one component of long‐term treatment.Method This study describes an intervention for people with intellectual disabilities and pica that included comprehensive management of the environment as well as behaviour treatment over a 9‐year period.Results Over a 9‐year period, nine surgeries for pica‐related incidents occurred prior to intervention; over the 9 years of intervention, pica surgeries were eliminated. Eighty‐five percent of participants experienced a 75–100% reduction in pica. Sixteen participants still had restrictive procedures including oral hygiene, overcorrection, contingent personal restraint, contingent mechanical restraint and visual screening with goggles. All continuous mechanical restraint that had been used in baseline was eliminated.Conclusion People with intellectual disabilities and dangerous pica can be protected on a long‐term basis from serious harm if proper management and clinical interventions are both employed. Although restrictive interventions were used on a long‐term basis, they were contingent upon a pica incident or pica attempts, which occurred much lower than in baseline sessions. Resident rights were protected throughout the intervention.

10557 Background: This observational reGISTry, initiated 11/04, characterizes the evolving patterns of care for GIST, such as the recent use and approval of Imatinib mesylate (IM) in adjuvant GIST. Methods: Data from consented pts (e.g. demographics, clinical characteristics, therapy, outcomes) are entered onto a web-based database. Updated analyses are performed every 6 months (mo), with data from unique sites being compared to the aggregate. Results: 792 pts enrolled from 121 centers, 55% from community practices. 79% were diagnosed with localized tumor, 87% of which received surgery as primary treatment. 94% had c-kit testing and 4% had mutational analysis performed at any time (1.4% of the pts in the community; 7.8% in Universities). 59% of pts had mutations in KIT Exon 11, 12% in Exon 9, 3% in Exon 17, 9% in PDGFRA Exon 18 and 18% had no detectable mutations. 13% of pts from Universities were enrolled in clinical trials vs 3% in the community. 78% of pts receiving IM at any time started at 400mg qd and 70% of pts receiving Sunitinib malate (SU) started at 50mg (4 wks on, 2 wks off). 6.6% of all pts received neoadjuvant IM, for a median of 4.3 mo for those pts that have completed (81%). 120 pts (15%) received adjuvant IM (13% of the pts in the community; 17% in Universities). Prior to Jun07 (ACOSOG Z9001 adjuvant IM positive results released) 14% of eligible pts received adjuvant IM vs 29% after Jun07. Median duration of adjuvant IM was 361 days for those pts that have completed (43%). Conclusions: reGISTry is a useful tool for measuring evolving pt management patterns in GIST capturing treatment variations from standard guidelines and differentiating management in Universities from that occurring in the community. Mutational analysis and clinical trial participation are still infrequent. The starting dose of IM and SU remains 400mg and 50mg, respectively, for most pts. The use of adjuvant IM has increased after Jun 07, suggesting that prescribing habits may have been influenced by evolving study data in these pts. [Table: see text] [Table: see text]