Behavior Modification

The Focus-Based Integrated Model (FBIM) tailors interventions based on a functional assessment of clients’ needs, integrating psychotherapy with pharmacological or rehabilitative support when necessary and emphasizing a strong Working Alliance (WA). This study evaluated therapeutic progress in clients treated with FBIM at four time points: baseline (T0), 3 months (T1), 12 months (T2), and follow-ups at 3 months post-therapy (T3). From April 2022 to July 2024, this longitudinal study was conducted at a community-based psychotherapy centre in Italy, enrolling 154 participants (M_age = 32.8 years; 54.3% female) who completed baseline assessments, with sociodemographic and clinical data collected on symptom severity, WA, and client motivation. Symptom severity declined significantly from T0 to T2. Within the integrated approach employed, that combined psychodynamic and Cognitive Behavioural Therapy (CBT) components, CBT showed stronger Task subscale scores at T2. Resistance to change impacted WA at T1 but decreased by T2. Contextual differences in WA at T1 diminished over time. Client motivation had no effect on WA. Structured approaches like CBT foster early collaboration, while changes in the WA over time reflect the therapist’s capacity to adapt to client needs and therapeutic challenges.

Evaluating psychosocial outcomes in families of children with chronic health conditions is complicated by heterogeneity in impact across and within conditions. This study used goal attainment scaling to assess individual families’ progress towards child behaviour goals following brief parenting support for families of children (2–11 years) with phenylketonuria (PKU). Twelve hospital-recruited families nominated up to two behaviour goals and completed baseline monitoring before attending two 2-hr Healthy Living Triple P group sessions. Monitoring was repeated at 4-weeks post-intervention and 4-month follow-up. Families reported partial or complete success on 20 of 23 goals by follow-up. Nine goals were PKU-related, focusing on formula intake for younger children and dietary independence for older children; 14 were general, targeting aggression/non-compliance in younger children, with older children’s goals more varied. Goal attainment scaling is feasible and effective for monitoring progress towards individually tailored child behaviour goals, with potential applications in research and clinical care.

Response interruption and redirection (RIRD) is a commonly evaluated intervention for reducing stereotypy, a core feature of autism spectrum disorder (ASD). Although RIRD has been recognized as an evidence-based practice, increasing emphasis on neurodiversity affirming and contextually grounded intervention has highlighted the need to reexamine both the methodological rigor of the literature and the conditions under which RIRD is appropriate. This systematic review evaluated the quality and ethical contextualization of published RIRD studies by applying the What Works Clearinghouse (WWC) single case design standards and an ethical decision framework informed by the National Institutes of Health guiding principles and contextual fit literature. A total of 42 articles met inclusion criteria, yielding 277 cases. Of these, approximately 9% met WWC design standards without reservations, 44% met standards with reservations, and 47% did not meet standards. Of the 144 cases eligible for evidence review, 67% demonstrated strong or moderate evidence of a functional relation. Ethical coding showed that most participants (76%) had an explicit rationale for treatment, yet reporting of procedural fidelity and social validity remained inconsistent. Only 38% of articles assessed social validity. Among those that did, stakeholder ratings were consistently positive, and participant-based measures indicated that when given a choice, individuals often preferred RIRD over alternatives. Taken together, findings suggest that RIRD can be effective and ethically defensible when implemented following established prerequisites such as contextual fit, functional behavior assessment, high fidelity implementation, and consideration of client preferences. Implications for practice and recommendations for designing neurodiversity affirming, high quality RIRD research are discussed.