Patrick Friman

University of Nebraska Medical Center | UNMC · Department of Pediatrics

A Correction to this paper has been published: https://doi.org/10.1007/s40614-021-00312-z

We happy few but why so few is a question initially posed by Skinner and subsequently posed by many members of the behavior-analytic community, and advocates for Direct Instruction (DI) are no exception. On the contrary, the limited extent to which DI has been adopted by the educational community is an abiding source of frustration for DI devotees....

From the beginning of recorded time human beings have assigned blame to persons who misbehave. The first prominent person to make an alternative case was Father Edward J. Flanagan, the founder of Boys Town, who proclaimed there was "no such thing as a bad boy, only bad environment, bad modeling, and bad teaching" (Oursler & Oursler, 1949, p. 7) in...

This article addresses the essential role of sleep in the medical, emotional, behavioral, and cognitive health of children. Sleep disorders common among children are defined along with the most common sleep concerns reported by caregivers. Prevention and intervention strategies are described.

Behavior analysis has contributed significantly to knowledge of behavioral dynamics and processes across species and settings. Clinical behavior analysis (CBA) is a major subdivision of behavior analysis, which involves the use of direct and indirect conditioning models to understand and address clinically significant behavior problems. Although ad...

This is an updated version of the chapter on anxiety published in the first edition of this book. Unfortunately, advances in the functional perspective on anxiety have been few since publication of that edition. Hundreds of papers on anxiety have been published since, but very few of these add to the anxiety literature with a functional perspective...

This comprehensive, 51-chapter handbook presents recent advances in the expression, etiology, assessment, and treatment of child and adolescent psychiatric disorders and related problems from a developmental psychopathology perspective. Following a broad conceptual overview of this area of clinical research and practice, assessment and treatment pr...

My heroes have always been cowboys. This is true (and also the name of a song written by Willie Nelson). Now, however, my heroes are behavior analytic researchers. They have provided the conceptual and empirical floorboards for behavior analysis, my beloved and chosen field. They have inspired, motivated, and vitalized me throughout my career and s...

Enuresis involves chronic urinary accidents occurring after the age at which children typically attain continence. Misunderstood, misinterpreted, and harshly treated throughout much of history, enuresis is now (relatively) well understood, its misinterpretations have largely been discarded, and effective treatment derived from behavioral theory is...

Primary pediatric medical care is as mainstream as any major cultural practice in the USA. Thus, publishing behavior analytic papers that pertain to problems that present in pediatric settings in pediatric medical journals is one route to mainstream relevance. With sufficient numbers of such papers, it could even lead to prominence. This article de...

Mainstream prominence was Skinner's vision for behavior analysis. Unfortunately, it remains elusive, even as we approach the 110th anniversary of his birth. It can be achieved, however, and there are many routes. One that seems overlooked in many (most?) behavior analytic training programs is what I call the front of the room. The front of the room...

This online resource for mental health practitioners presents a variety of information required in daily practice in one easy-to-use resource. Covering the entire spectrum of practice issues–from diagnostic codes, practice guidelines, treatment principles, and report checklists, to insight and advice from today's most respected clinicians–this peer...

Focuses on residential care that involves a behaviorally oriented, family-style program for youth whose own families are untenable and who are either unsuitable for foster care or have no foster care options. The author also reports on biological children of couples who provide care. Data are presented that describe experimentally derived outcomes...

Nocturnal enuresis, or enuresis, is a very common parasomnia affecting 5–7 million children annually. It is largely an inherited condition wherein children involuntarily pass urine while asleep. Nocturnal enuresis affects 15–20 percent of 5-year-old children, with as many as 10 percent of those children remaining wet at 10 years of age. Prevalence...

Behavior analysis is a generic science, and Skinner's vision for it was that it would become a mainstream force, relevant for most if not all human concerns, major and minor. Clearly his vision has not been realized. Determining why this is the case would require a complex multifactorial analysis. One likely factor is that the majority of its basic...

At last, the field of applied behavior analysis has a beautifully crafted, true textbook that can proudly stand cover to cover and spine to spine beside any of the expensive, imposing, and ornately designed textbooks used by college instructors who teach courses in conventional areas of education or psychology. In this review, I fully laud this dev...

Encopresis is a common, often undertreated, and often overinterpreted form of fecal incontinence. When left untreated, encopresis can lead to serious and potentially life-threatening medical problems and seriously impaired social acceptance, relations, and development. The primary reasons for the medical problems are the possibility of organic dise...

Enuresis is the technical term used for the regular passage of urine into locations other than those specifically designed for that purpose. The diagnostic criteria in the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) include repeated voiding of urine into clothing o...

In this chapter, we describe the assessment and treatment of enuresis and encopresis. We first review literature on the symptoms, causes, and evidence-based treatments of each condition separately. We also incorporate a discussion of the mechanisms of change underlying effective intervention. Then, using Ryle’s (1949) distinction between “knowing h...

The alimentary process terminates with the elimination of waste, specifically urine and feces. Among the most common, persistent, and stressful presenting complaints in primary medical care for children are two disorders involving developmentally inappropriate elimination of waste— enuresis (urine) and encopresis (feces). Evidence is found for thei...

There is no technical definition to define anxiety. Currently, the most widely used categorical term for fear that does not involve true danger is anxiety, and this chapter addresses it from a functional perspective. There is a widespread assumption that anxiety is distinct from fear in some essential way. Anxiety is reported to co-occur so prevale...

Two of the most common presenting complaints in primary medical care for children involve disordered elimination, specifically enuresis (urine) and encopresis (feces). Multiple physiological factors are associated with them, the most important of which are colonic motility, constipation, and fecal retention. Encopresis were earlier viewed as a prob...

To evaluate the Bedtime Pass Program (BPP), an extinction-based procedure for treating bedtime resistance in typically developing children. A randomized, controlled trial in which nineteen 3- to 6-year-old children demonstrating bedtime resistance were randomly assigned to a Bedtime Pass or Monitoring Control group. The experimental condition invol...

This chapter will discuss the two predominant forms of oral-digital habits, thumb/finger sucking (finger sucking hereafter) and onychophagia (nail biting hereafter) in terms of their demographics, phenomenology, causes, functions, and clinical associations. The two habits are obviously similar topographically. The extent to which this similarity ex...

Functional encopresis (FE) refers to the repeated passage of feces into inappropriate places at least once per month for at least 3 months. Treatment of FE targets the processes that cause orexacerbate the condition, including reduced colonic motility, constipation, and fecal impaction. The cardinal elements of successful treatment include “demysti...

This article presents results from an investigation using functional as- sessment strategies in a general education classroom for an early adolescent diag- nosed with ADHD/ODD. In the first phase of the assessment, data were collected from teacher interviews, student interviews, and direct observations to generate hypotheses regarding the associati...

Nocturnal enuresis is one of the most prevalent and distressing of all childhood problems. The treatment of nocturnal enuresis has shifted in the past few decades from a strictly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of this disorder are medical/organic, there iscurrently strong eviden...

John Weisz is a truly bright and still brightening light among the group of clinical researchers whose research efforts are devoted to clinical child issues, but he also seems to have a specially tuned and trained ear to hear the needs of the clinician and a desire and ability to address them. His new book Psychotherapy for Children and Adolescents...

The current study constitutes the first attempt to generate repertoires of relational responding, as generalized operant behaviors, when they are found to be absent in young children, using interventions suggested by Relational Frame Theory. Three children, aged between 4 and 6 years, were exposed to a basic problem-solving task that involved two o...

Little research has been published on tattling, even less on its social impact, and we found none directly investigating tattling by adolescents. This study assessed the extent to which tattling, as perceived by peers and caregivers of adolescents in a residential care program, was associated with various dimensions of social status and other behav...

The purpose of this study was to assess the concurrent criterion validity of the attention-deficit/hyperactivity disorder (ADHD) portion of the National Institute of Mental Health Diagnostic Interview Schedule for Children-IV (NIMHDISC-IV). Fifty-seven adolescent participants were divided into three groups on the basis of whether participants met c...

Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3...

Simplified regulated breathing (SRB) has been demonstrated to reduce or eliminate stuttering in children. However, much of the current research has evaluated the intervention with school-aged children within educational contexts. In the current case report, we extended the application of SRB by evaluating its effectiveness in treating stuttering di...

Branch and Vollmer (2004) argue that use of the word behavior as a count noun is ungrammatical and, worse, mischaracterizes and ultimately degrades the concept of the operant. In this paper I argue that use of behavior as a count noun is a reflection of its grammatical status as a hybrid of count and mass noun. I show that such usage is widespread...

Diaper use is widespread and possibly even increasing across diverse populations in the United States, ranging from infants to very old adults. We found no reports of an experimental analysis of the effect of wearing diapers on the frequency of urinary accidents and the attainment of continence skills (e.g., urinating in the toilet). In this study,...

This case study describes the use of functional assessment in combination with experimental functional analysis as methods for informing and evaluating individualized treatment in a large residential treatment setting for adolescents. The case of John, a normally developed 12-year-old male, illustrates how functional information can be used to deri...

The authors evaluated the effects of response prevention, a treatment previously shown to be effective for routine thumb sucking and suggested to be effective for early onset trichotillomania, applied to hair pulling in a 2-year-old. Response prevention was used alone in two settings (bedtime and naptime) and combined with a brief time out in anoth...

To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. Secondary data analysis of a large epidemiological data set (n = 1,286) produced a series of gate and contingent items for each diagnosis...

This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tic...

Group intervention for antisocial youth has received harsh criticism in recent years. This paper reviews relevant research focused on the influence of contact with delinquent peers on the development of antisocial activity. Also reviewed are studies reporting outcomes of group intervention for antisocial youth. Although a few studies have found iat...

Using recently refined diagnostic criteria, the authors hypothesized that the frequent touching of others by a 16-year-old male adolescent with Tourette's syndrome was a compulsion and not a tic. Consistent with the study's hypothesis, the authors applied exposure and response prevention, a procedure empirically supported for treatment of compulsio...

The authors provide 3 case examples of the evaluation of assessment-based intervention strategies within the natural classroom context for students (aged 11, 14 & 14 yrs) with attention deficit hyperactivity disorder (ADHD) and comorbid disorders. For each of the participants, several hypotheses were generated concerning potential environmental cor...

We administered the Diagnostic Interview Schedule for Children (DISC) two times to a group of youth (222 boys, 147 girls) entering residential care, once at their time of entry and once 1 year later. We then compared their DISC outcomes on Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) against changes in independent direct observatio...

This study assessed the effects of positive peer reporting (PPR) on the cooperative behaviors and peer acceptance of 3 socially rejected, delinquent youths (2 males and 1 female) in residential care. PPR involved rewarding classroom peers with token points for publicly praising the social behavior of target students. A nonconcurrent multiple baseli...

Comments on the article by R. W. Robins et al (see record 1999-00297-003) which examines trends in the prominence of 4 major schools of psychology by examining citation index trends and the content of articles in mainstream journals and dissertations. The authors argue that behaviorism is quite healthy and discuss the validity of Robins et al's met...

This brief comment presents my clinical interpretation of the problems presented by Mike, a 13-year-old Caucasian male living at Boys Town, as described in his case description. My perspective on the case is behavior analytic, and my interpretation is that it involves profound social-skills deficits. To begin, I recommend a comprehensive functional...

This study examines the effects of a "transitional object" (surgical cloth) on the thumb sucking of a 3-year-old boy in two conditions: while sitting in the lap of his physical therapist and while alone in his crib. Sucking occurred when the cloth was present and did not occur when it was absent, regardless of condition. These results are discussed...

We studied how rewarding youth in residential care for publicly reporting positive social behavior influenced the social interactions and acceptance of their most socially isolated peers. Results showed that the intervention resulted in substantial improvements in social interactions by the previously isolated peers. Peer acceptance ratings also im...

To evaluate a novel intervention for bedtime problems. We used an ABAB withdrawal-type experimental design. The intervention was prescribed in an outpatient primary health care context and evaluated in the home setting. Two normally developing boys aged 3 and 10 years were the primary participants. Twenty parents and 23 practicing pediatricians rat...

Treatment of bedtime problems is often impeded by adverse effects. Soporific drugs can have diurnal carryover effects and rebound when they are withdrawn. Letting children sleep with parents can complicate marital relationships and delay development of independent practice of bedtime skills. Ignoring childrens' crying after bedtime can lead to incr...

This study used a multielement baseline design to analyze the effects of token rewards delivered contingent upon completion of math problems by 2 middle-school boys. Time spent on math and number of work pages completed increased (with high accuracy) during reward conditions and were maintained during fading and withdrawal. At follow-up time spent...

This study compared scores on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for samples of youths in 3 out-of-home placements with varying levels of restrictiveness. Mean CBCL T scores were more than a standard deviation higher than mean YSR T scores on the broadband scales and about 2/3 of a standard deviation higher on the syn...

This study compared scores on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for samples of youths in 3 out-of-home placements with varying levels of restrictiveness. Mean CBCL T scores were more than a standard deviation higher than mean YSR T scores on the broadband scales and about 2/3 of a standard deviation higher on the syndr...

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and cont...

Some type of suicidal communication precedes 80% of attempted and completed suicides in adolescents. This study investigates the relationship between the number of suicidal communications prior to an attempt and the lethality of the attempt in a sample of adolescent youth residing in a residential treatment facility. The sample consisted of 46 yout...

To determine if primary nocturnal enuresis (PNE) is accompanied by significant behavioral comorbidity. A survey design using a standardized behavioral rating scale. Behavioral pediatric clinics in the Midwest. Subjects with PNE (n=92) were selected from 122 consecutive referrals for enuresis. Criteria included age 5 years or older, PNE status, and...

A key concept in the continuum-of-care model is matching the restrictiveness of treatment to the level of youth behavior problems. Restrictiveness refers to the degree that treatment and setting constrains choices and limits freedoms of patients. Only a few investigators have examined this relationship, and the findings have been equivocal. Extendi...

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systemat...

Historically, anxiety has been a dominant subject in mainstream psychology but an incidental or even insignificant one in behavior analysis. We discuss several reasons for this discrepancy. We follow with a behavior-analytic conceptualization of anxiety that could just as easily be applied to emotion in general. Its primary points are (a) that lang...

This chapter will discuss enuresis and encopresis, the two most commonly occurring elimination disorders in children. Although the primary clinical features of both disorders are medical/organic, a fusion of medical, psychological, and behavioral literature supports biobehavioral methods of assessment and treatment as state of the art. For many yea...

An intervention for disruptive boys in residential care involving increases in positive to negative interactional ratios is described. The target of the intervention was daily problem behavior. Results from a pooled time series analysis of the data revealed a significant decrease in behavior problems (one problem per boy per day) during the interve...

We evaluated the effectiveness of an abbreviated habit reversal procedure to reduce maladaptive oral self-biting in an adolescent boy in residential care. Treatment involved a combination of relaxation and two competing responses. Results of a withdrawal design and two posttreatment medical evaluations indicated that the intervention eliminated the...

Evaluated the effects of performance feedback on levels of treatment integrity in school-based behavioral consultation. Three teachers employed in a residential treatment community were responsible for treatment implementation. Treatment integrity was defined as the percentage of 2-min intervals during which contingent teacher reinforcement for stu...

We evaluated a program to protect the placements of 23 highly troublesome youth in voluntary residential care by reducing youth-to-staff ratios. Specifically, the youth were moved from regular program homes (with eight youth) to reduced ratio homes (with only four youth) instead of being terminated from the program. We provide evidence supporting t...

To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The...

There is extensive literature on disruptive behavior and on anxiety and a growing literature on co-morbidity. But there is little literature on co-morbidity between disruptive behavior and anxiety, and we found none that specifically discusses social phobia. Because internalizing problems are more difficult to detect than externalizing problems, th...

We studied how rewarding peers for publicly reporting positive aspects of a socially rejected girl's behavior affected her social interactions and acceptance. The results indicated that positive peer reports reduced negative social interactions (to near zero) and increased positive interactions (to above 70%). In addition, social acceptance ratings...

School performance and attitudes of a group of children placed in residential care were assessed during placement and for an average of four years after discharge. A comparison group of children who were not placed in the program was also followed. The residential program emphasized both behavioral and educational treatment. Group differences were...

Early basic research showed that increases in required response effort (or force) produced effects that resembled those produced by punishment. A recent study by Ailing and Poling determined some subtle differences between the two behavior-change strategies, but also confirmed that increasing required effort is an effective response-reduction proce...

Pediatricians are often asked to advise parents who are having difficulty managing the oppositional behaviors of their toddlers and preschool-age children. A large number of articles provide advice to pediatricians and parents on effective disciplinary strategies. However, despite the fact that verbal explanations, reasoning, and instructions are c...

Range and Cotton (1995) showed that many of the articles reviewed in their study did not include a line specifying institutional review board-approved procurement of informed parental permission and child assent for child research. Range and Cotton stated that the absence of the line suggests a lack of sensitivity to permission/assent issues, impli...

We evaluated the effects of two health education teaching methods, a pamphlet based on a task-analyzed checklist and two professionally developed films, on the completeness, accuracy, and maintenance of testicular self-examinations (TSE). Subjects (N = 48) were videotaped while performing a TSE after training and at a follow-up visit. Direct observ...

We report the effects of using a urine alarm, typically employed for nocturnal enuresis, to treat chronic diurnal enuresis in a 15-year-old female resident at Boys' Town. The results of an ABAB reversal design indicate that the alarm eliminated wetting in both treatment phases and that continence was maintained at 3- and 6-month follow-up.

It is estimated that enuresis affects 5 to 7 million children in the United States. Although the problem is common and well known, appropriate and effective treatment is not always provided. This may be due to the many etiological theories associated with this condition as well as a correspondingly high number of interventions. The present paper su...

Studied the relationship between chronic thumb-sucking and behavior problems reflective of psychopathology. Compared scores on the Child Behavior Checklist (CBCL) and Eyberg Child Behavior Inventory (ECBI) for matched samples of thumb-sucking, referred, and nonreferred children. Mean scores for the thumb-sucking and nonreferred samples were equival...

Injuries are the major causes of death for children. Pediatric psychology offers significant contributions to the multidisciplinary efforts necessary to prevent injuries and reduce harm to children. This Task Force Report reviews epidemiological data, characteristics of children's injuries, passive and active interventions for reducing injuries, an...

A fundamental goal of the continuum of care concept is high correspondence between child dysfunction and program intrusiveness. Yet the small body of relevant research has identified major discrepancies. We used the Child Behavior Checklist to compare entry-level behavior problems of children from five child mental health programs sequenced in orde...

Trichotillomania is a behavioral disorder characterized by habitual hair pulling resulting in alopecia. Although once considered extremely rare, a recent survey study of college freshmen suggests a lifetime prevalence of more than 3% in females and more than 1% in males.1 The recent literature on trichotillomania has emphasized the pharmacologic tr...

Many psychologists believe a Kuhnian revolution, a competitive event between incommensurate paradigms in which a winner displaces losers after chaotic upheaval, has occurred in psychology. Cognitive psychology is said to be displacing behavioral psychology and psychoanalysis, but few published data support this thesis. Social science citation recor...

Chronic thumb sucking in school-age children may reduce peer social acceptance, an important contributor to social development. The influence of thumb sucking on social acceptance was assessed among 40 first-grade children, who were shown four slides of two 7-year-old children (one boy, one girl) in two poses (one thumb sucking, one not). After vie...

We evaluated the accuracy of primary health care providers' predictions of parents' adherence to their children's short-term antibiotic regimen and a scheduled follow-up appointment. Adherence predictions were compared with objective measures of the parents' adherence. Providers were poor predictors of nonadherence, greatly overestimating the perce...

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group...

Alternative mental health services for children such as parent training are expanding across the country. Yet the clinical picture of the children served in these programs is incomplete. In two studies we compare scores from standardized behavior problem inventories for groups of children from a parent training class with scores from groups of chil...