Although providing consequences, such as relocating a resident to his/her bedroom after agitation occurs, has been used successfully, most consequent strategies involve the use of verbal praise or planned ignoring, and are integrated into a treatment plan that focuses on antecedent techniques. Planned ignoring involves terminating caregiver attention when it is believed that attention is reinforcing the problem behavior. For example, caregivers are taught never to argue with a dementia patient because, although arguing may appear aversive, this response can actually reinforce a patient's contentious behavior (e.g., insisting that this is not her home). Planned ignoring of the patient's statements, combined with getting him/her onto another topic (an antecedent strategy), is often effective in diverting an unpleasant verbal interaction.
Another example of consequent strategies combined with antecedents is the use of prompted voiding for urinary incontinence. In prompted voiding, patients with dementia are verbally prompted (i.e., reminded) to use the bathroom every one or two hours. Verbal prompting is an antecedent to using the bathroom. However, an important component of prompted voiding is the provision of verbal praise after the patient uses the toilet appropriately (reinforcing consequence).
Behavior management techniques are considered by many to be the most effective form of treatment for the unique problems and psychopathologies associated with dementia. Other forms of behavioral therapy, including problem-solving skills training and cognitive-behavioral therapy are used commonly among older adult populations without dementia-related impairments.
LOUIS D. BURGIO SUSAN E. FISHER
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