Behavioral assessment for pediatric intensive care units.
A five-minute individual play session flips PICU kids from fussy to focused, and the same test-then-treat model now works at home and school.
01Research in Context
What this study did
Doctors in a pediatric ICU gave alert kids short one-on-one play sessions. They ran an ABAB reversal to see if the play changed behavior.
Staff picked simple activities like puzzles or coloring. They watched for attention, smiles, and problem acts before, during, and after each round.
What they found
When the activity was on, kids looked longer, smiled more, and acted out less. When it stopped, the gains faded. The pattern repeated in every reversal.
The brief play worked fast and needed no extra medicine or machines.
How this fits with other research
Livingston et al. (2021) took the same quick-test idea home. Parents ran a 5-minute RAAT to find the right kind of attention for their child.
Strohmeier et al. (2018) used a 10-minute RAAT in clinic rooms. Both later studies kept the short reversal logic but swapped toys for social praise or eye contact.
Sottilare et al. (2023) moved the concept into classrooms. Check-in/Check-out gives scheduled adult attention each morning and afternoon, lifting engagement much like the 1979 play sessions did for PICU kids.
Why it matters
You can borrow the PICU playbook anywhere time is short. Keep a shoebox of quick tasks—stickers, mini-puzzles, coloring sheets. When a client looks bored or restless, run your own 5-minute reversal. Deliver the item, watch the behavior, pull it back, then bring it again. The clear on-off pattern tells you in one session if the activity is worth putting in the behavior plan.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pack three small solo activities and run a 5-minute ABAB probe to see if engagement jumps.
02At a glance
03Original abstract
Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.
Journal of applied behavior analysis, 1979 · doi:10.1901/jaba.1979.12-83