Treating eye injuries; avoiding holiday poisonings; resistance to change: Upstate Medical University's HealthLink on Air for Sunday, Dec. 3, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a professor of vision research explains work on a new way to treat corneal injuries.

Audrey Bernstein, PhD: ... In general, we would love it if we had a new therapy that closed the corneal wounds, prevented scarring and was not a steroid. ...

Host Amber Smith: An educator from the Upstate New York Poison Center offers some holiday precautions.

Mary Beth Dreyer: ... There's a high concentration of nicotine in those vape cartridges, so it's really important to properly store tobacco or cannabis products up out of sight, out of reach of little kids. ...

Host Amber Smith: And a behavior analyst discusses resistance to change.

Andy Craig, PhD: ... It's important to understand that persistence in and of itself is not a good thing, and it's not a bad thing. It depends on the behavior that you're talking about, and it depends on the situation. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll go over some poison precautions for the holiday season.

Then we'll learn about the study of resistance to change, from a behavior analyst.

But first, Upstate researchers are working on a new method of treating corneal injuries to prevent scarring.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Researchers from Upstate took the top prize in a State University of New York competition for startup business pitches. They want to change how corneal injuries and the scarring that can lead to vision loss are treated. Here to talk about the team's work is Dr. Audrey Bernstein. She's a professor of ophthalmology and visual sciences, biochemistry and molecular biology, and cell and developmental biology at Upstate. And she's co-founder of the DUB -- (spelled D-U-B) -- Biologics startup. Welcome to "HealthLink on Air," Dr. Bernstein.

Audrey Bernstein, PhD: Thank you.

Thank you so much for having me.

Host Amber Smith: We want to understand your project, but first can you explain a little about corneal injuries and how they're treated now? How common are corneal injuries?

Audrey Bernstein, PhD: Sure. Corneal injuries are actually very common both in the United States and certainly throughout the world. You can have an injury that is a mechanical injury, just as you would imagine -- something hits your eye. But there's a lot of underlying diseases that can cause problems with your cornea. So this can be what we would call a corneal ulcer, if you have an infection and it doesn't heal properly. Also, there's conditions that a lot of people have heard of called dry eye, and sometimes dry eye is just dry eye, and sometimes it progresses to where it really affects the top layer of your cornea called the corneal epithelium. And that causes problems with wound healing in the cornea if it advances to that stage.

So there's a lot of, actually, what are called indications of problems with the cornea. And, your cornea is the most highly innervated tissue in your body, and so, as everyone knows, when you get something in your eye, or you have something wrong with your eye, it really, really hurts. So the cornea is a very specialized tissue, and we want it to work perfectly.

Host Amber Smith: Do corneal injuries always cause scarring?

Audrey Bernstein, PhD: No, they certainly don't. The cornea is made up of a few layers, and so the top layer is the epithelium, and we call the middle layer the stroma. And between those two layers, it's what's called the basement membrane.

So if you have just an epithelial, small scrape, it still really hurts, but it usually heals just fine. If you have a chronic condition where you're then upsetting the basement membrane and getting further into the cornea, that's where it really can start to have a scarring outcome.

Host Amber Smith: So what happens currently for someone who has a corneal injury? How are they typically treated?

Audrey Bernstein, PhD: So typically people are treated with the mainstay of steroids and antibiotics. The antibiotics are fine. The steroids have variable outcomes. Sometimes it works just fine, and other times it doesn't work, and it's very hard to predict which person, under which condition, will have which outcome.

In addition, steroids have the unfortunate side effect of producing higher over time -- not immediately, but over time -- higher interocular pressure. And that pressure in your eye is linked to the development of glaucoma, which is another eye disease. In general we would love it if we had a new therapy that closed the corneal wounds, prevented scarring and was not a steroid.

Host Amber Smith: Yeah, that sounds great. Now, corneal injuries, how often do they lead to blindness?

Audrey Bernstein, PhD: So that is a hard question to answer because it, to some degree, depends on where you live. If you're in a First World country, there's still, unfortunately, a lot of people -- and I can get into what people do in that case -- but in Third World countries, it's the leading cause of blindness because you don't have the interventions that you have here.

So what is the intervention? You can get a corneal transplant, and that's obviously not something that doctors do quickly. And it's not taken lightly. It's a tissue transplant, and although it has a reasonably good success rate, it's very tricky in terms of the outcomes and taking the medications that you're required to stay on over time and the potential of rejection later. So obviously, like any tissue transplant, if you can save your own tissue, that's preferable to having to go through a transplant procedure.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Professor Audrey Bernstein about corneal injuries.

Now, what can you tell us about the DUB Biologics project you're involved in?

Audrey Bernstein, PhD: Sure. So we go by "DUB" Biologics. And this is an academic spin-out or startup from my work. I'd say it's sort of at the end of 10 or 15 years of academic work and getting to a point in saying, "Well, we think we have something that we can help people with."

So as of 2022, we started. I'm a co-founder in DUB Biologics. And we have a therapeutic, as we've been talking about, for the cornea, and we're now expanding into skin. So we think the things that happen in the cornea, very similar outcomes happen in the skin. And skin, we can also talk about diabetic wound healing, bedsores, et cetera. There's a lot of indications that have the same biological or similar biological underpinnings that our drug could address.

Host Amber Smith: So do you work on the skin first before you try this in the eye, or have you already tried this in the eye?

Audrey Bernstein, PhD: OK, so just to take this back a second. We do not have an FDA, we do not have an approved therapeutic. So that is a long road to getting approval to being able to go into patients.

So right now it's still in the world of academic research. I think within two years we will try to get FDA approval for patients. And from there, again, you have a long road through the trials for safety first, of course, safety, and then efficacy. So it's really a long process that's highly, highly regulated.

We are not there yet, but I agree that we might try in skin first for safety and go from there. So it's probably another 10-year road before you have a fully approved drug that's on the market.

Host Amber Smith: So when you say a therapeutic, are you talking about a brand new medication, or is it a existing medication that you're using in a new way?

Audrey Bernstein, PhD: This is a new medication. It is a topical liquid. When dropped on the surface of either the cornea or the skin, it will get into the cells. And it stops production of a certain protein that causes scarring and causes inflammation. So if we knock down that protein, we then can close the wound faster and avert scarring. And so the exciting part of this is most drugs, especially for the eye, need to be dosed frequently. And anyone who has any kind of eye problem, whether it's cornea, whether it's glaucoma, et cetera, they will tell you that they do not like the eye drops, because it's four times a day, six times a day, for weeks and months, and people hate it.

So our drug, our class of drug, enables you to have one drop. And it has efficacy -- which means it works -- for three months. So that's a big change. So that's what we think is a very exciting, would be a very exciting, advance, again, after safety is established.

Host Amber Smith: So is it working to prevent scarring, or is it working to promote wound closure, or both?

Audrey Bernstein, PhD: Great question. So, the first thing, the two things are intertwined, because if you promote correct wound closure, then you avert scarring. And so the two things are very, very closely linked. And the reason is that your immune cells are critically important to stop infection, but if the immune reaction stays, and it turns into a chronic situation, this often leads to scarring.

So if you can close the wound quickly, and this is just generally true in your body, then you're going to avoid the infection. You're going to lower your immune response. And you're going to prevent scarring. So it's really all linked together.

Host Amber Smith: So do you think there would be any potential for it to be able to reverse damage that's already been done? Say somebody who had an injury and some scarring from months ago or years ago ... would this work on that?

Audrey Bernstein, PhD: That's a great question.

We don't have a lot of data on reversing. That's kind of the holy grail of any kind of therapeutic like this. It's possible that it could, and with other drugs there is some data to show that it is possible to reverse scarring and fibrosis. So I haven't used the word fibrosis a lot, but just to introduce it here, scarring is very similar to what people have heard of as lung fibrosis and liver fibrosis.

So, so far we've talked about topical things, cornea, it's the front of your eye, and skin, but are further things that we're thinking of down the line are lung fibrosis, and so that would be, for instance, drug delivery with the nebulizer. So that's where we get into not only preventing but reversing disease. So I don't have enough data to promise you that we can do this, but we are hopeful that it's possible.

Host Amber Smith: Well, that is exciting. Now, the competition that DUB Biologics won is called the SUNY Startup Summer School. It's something that's held every year. Can you talk a little bit about the goal behind the competition and why you were involved in it?

Audrey Bernstein, PhD: Sure. So our team, and I should have introduced this before, I'm a co-founder of DUB Biologics, and I founded this company with Tere Williams. She is the CEO. And she participated in an S4 summer class given by the research foundation. And this is sort of training for startup companies to understand, really, how to run a business like this, because these businesses are often started from academics who are scientists that don't have a tremendous amount of business experience. So it's really a training class, and it leads up to what's called "demo day," which is what's called a pitch competition. You have a certain amount of minutes, six minutes or eight minutes, or a certain amount of slides to tell your story. And this is your story of, it's not so much a science story but it leverages the science, and it tells the business story, the potential that the therapeutic has and the potential of the business. And we were fortunate to be able to pitch in that competition, and we were winners that day.

Host Amber Smith: It sounds a little like (the television show) "Shark Tank."

Audrey Bernstein, PhD: It's exactly like "Shark Tank."

Host Amber Smith: What were some of your competitors? Do you remember any that piqued your interest, or did you even hear any of the others?

Audrey Bernstein, PhD: We heard the others. You know, there's a wide, an incredibly interesting, wide variety of technologies having to do some therapeutics, some batteries -- there's a lot of interest in improving energy sources -- some had to do with online teaching platforms. So it's a very varied group. It's not just based on therapeutics.

Host Amber Smith: Well, I know you talked about -- I mean, this is a long-term thing. It's not like there's going to be a product on the shelf tomorrow, and it's step by step through the FDA before you can even get approval -- but where are you scientifically? How far out are you from clinical trials, say?

Audrey Bernstein, PhD: It is a very long road. And as I said, we've done a lot of years of research in the lab. In terms of the company, though, we're really at the beginning stages. Our hope, and I think it is realistic, that we could have approval for a pilot study in people in two or three years. And then from there, it all depends on, again, safety and efficacy. But you have to go through the clinical trials with large numbers of people and to figure out if it is safe and effective. And so that is a long, a long-term project, as I said, about 10 years. But I do think in two or three years we will be into our first study in patients.

Host Amber Smith: Well, very interesting. Well, congratulations, and thank you so much for making time to tell us about it.

Audrey Bernstein, PhD: Thank you so much. I enjoyed talking to you.

Host Amber Smith: My guest has been Dr. Audrey Bernstein. She's a professor at Upstate in ophthalmology and visual science, biochemistry and molecular biology, and cell and developmental biology, and she's also co-founder of DUB Biologics. I'm Amber Smith, for Upstate's "HealthLink on Air."

Poison prevention reminders -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." It's easy for accidents to happen when families get busy with activities during the holiday season, and typically the Upstate New York Poison Center receives an increase in the number of calls during this time. Here to talk about the sorts of calls that come into the poison center in December is public health educator Mary Beth Dreyer. Welcome to "HealthLink on Air," Mrs. Dreyer.

Mary Beth Dreyer: Hi, thanks for having me.

Host Amber Smith: I know that the Poison Center serves 54 counties of Upstate New York from the Canadian border to the Pennsylvania border. And before we talk, let me let listeners know they can reach the Poison Center 24 hours a day, seven days a week, at 1-800-222-1222. And that's a free call, and it's free information. Now are you seeing an increase in calls collectively from all the regions of Upstate New York?

Mary Beth Dreyer: You know, there's definitely times during the year where our call volume increases, and we see an uptick of calls during the month of December from all the 54 counties that we cover.

Host Amber Smith: And what do you attribute that, just to families and people being busy, or are there other reasons?

Mary Beth Dreyer: You know, I do think people are busy. We have a lot on our plates during the month of December. I think that there's a lot of, a lot of people getting sick this time of year, too, so things might be a little bit more readily available. So a lot of different things contribute to the increase in calls.

Host Amber Smith: What types of calls do you think you get more in December than other times of the year?

Mary Beth Dreyer: Our No. 1 call last December, for all the ages in our coverage area, is pain medicine. That means an unintentional overdose, taking maybe a double dose of a pain medicine, or a child getting into the wrong medicine.

Host Amber Smith: So if children, in particular, are getting into medications that are accidentally left out because mom has a cold or whatever, or if maybe they get a double dose of a prescription if one parent gives the child the medicine without the telling the other parent, and they accidentally give them a double dose, and the parent calls the poison center for that situation, what can they expect? What does that call go like?

Mary Beth Dreyer: Well, in order to determine what type of care is needed, one of our highly trained nurses or pharmacists that answers our phone calls would ask a number of questions of the parent who calls. They would ask, what has the child eaten or swallowed? How much of it, if it's, you know we can look at a pain medicine bottle and realize, before I saw it was half full, and now there's only four or five tablets left. So we would want to know approximately how much of the item a child got into. And also how much the child weighs. And, what's going on? Is the child vomiting? Do they have a fever? Are they having difficulty breathing? So we really try to assess what's happening at that time. So all that information helps our specialists determine what type of care is needed for the child.

Host Amber Smith: What are the general guidelines about when the child may need emergency treatment at the hospital?

Mary Beth Dreyer: Well, anytime a child or a person is having difficulty breathing, they lose consciousness or they're having seizures, it's recommended somebody go to the ER (emergency room).

Host Amber Smith: OK. Well, you mentioned that they ask about the things that the child ingested. It might not be medication. It could be something else. What are some of the other products that you hear about kids ingesting accidentally?

Mary Beth Dreyer: Well, little kids get into everything, as we know. They're curious, especially toddlers. They like to put things in their mouth. So we get phone calls, yes, about pain medicine, about medicine tablets. A lot of times it looks like candy. But we get calls about possible cleaning products that kids, you know, because they're colorful. They smell good. They might be left unattended on a table because, again, it's a busy time of year. So they may be drinking, accidentally or unintentionally, drinking a cleaning product.

And then we get into things like alcohol and vape products, cannabis products that just are unintentionally left on a table or on a counter, on a coffee table, that are just accidents waiting to happen.

Host Amber Smith: How dangerous are cigarette butts or vape juice, because you think of that as trash or garbage. But can they be dangerous for kids?

Mary Beth Dreyer: For sure. Absolutely. Little kids are small. Their bodies are little. They're not as developed. So things like nicotine or cannabis can certainly be poisonous to them. There's a high concentration of nicotine in those vape cartridges, so it's really important to properly store tobacco or cannabis products up out of sight, out of reach of little kids.

Host Amber Smith: And so if you suspect your child did get into that, that would warrant a call to the poison center?

Mary Beth Dreyer: Absolutely. Definitely give us a call. Those are the types of calls that we receive.

Host Amber Smith: Now, in terms of liquor, I'm imagining glasses that are left unattended, or the morning after a party. Is that kind of what you hear about?

Mary Beth Dreyer: Absolutely. Same thing goes with the alcoholic drinks. They are bright. They have fruit in them this time of year. You know, we try to always do a little extra at the holiday season. So they smell good. They look good. Kids like to mock what adults are doing. And if they're left unattended, a parent gets distracted, a parent is sleeping in the next morning, and things are left out, those are all or can be dangerous to small children.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Mary Beth Dreyer. She's a public health educator at the Upstate New York Poison Center, and we're going over the types of calls that typically come into the poison center during the holiday season. The poison center is available 24/7 to answer questions at 1-800-222-1222, and there is no charge.

So let's talk about holiday decorations. Do you get calls about poinsettias, holly berries, Christmas lights, tinsel? What types of holiday decorations can pose a problem?

Mary Beth Dreyer: We get calls about all sorts of holiday decorations and plants. Again, like I've said in the past, it's really important to keep things out of reach of little kids and pets. You know, if a parent is crafting with small children -- I know that's a popular thing to do with young kids this time of year -- it's important to supervise them, making sure that they're not putting things in their mouth. And practice proper hand washing once they're finished. And things like decorations and plants, they're colorful. They're bright. They're attractive to little kids. So you can see where an unintentional poisoning can happen because, again, kids are curious and the way that they explore is through their mouths, especially our little kids.

So just a quick note about poinsettias. It's hard to believe that they're not toxic to people, and generally calls that come into the poison center about them, they don't end up needing medical care. But things like holly berry, mistletoe, boxwood, amaryllis -- all popular plants this time of year that people use to decorate their houses, or might give them as gifts -- they can be poisonous. So the poinsettia might be a safer option to decorate with or to give to somebody, especially if they have little kids or pets in their house.

Host Amber Smith: The holiday season for many families includes special meals. Regarding food, are there precautions you'd like to remind people about?

Mary Beth Dreyer: Oh, for sure. I mean, holidays and eating, they just kind of go hand in hand, right? So, I would say when you're starting to celebrate and you're hosting, you're expecting a lot of people, so you're cooking. You know, start with a clean work surface. Wash your hands. Follow directions and cook foods to its recommended temperature. You know, use those meat thermometers to be sure that the food is cooked thoroughly. And just generally speaking, be sure to keep hot foods hot and cold foods cold. And generally, as a rule of thumb, try not to leave your food out on the counter or on your table for more than two hours. And after everything is said and done and you refrigerate or freeze your leftovers, disinfect all of your food preparation in your food service areas, just as an extra level of precaution.

Host Amber Smith: Does the poison center get calls from people who think they got sick from eating something that was spoiled?

Mary Beth Dreyer: We sure do. And I would encourage people to, if they're experiencing symptoms of food poisoning, their stomach is upset, they have some intestinal issues going on, they're just feeling off, they might have a fever, absolutely give us a call. And really, in terms of advice, it's really going to depend on each person and what's going on with them. Each case, as you can imagine, is treated individually. But certainly give us a call if they think that somebody, either themselves or somebody in their house. Is experiencing food poisoning.

Host Amber Smith: Now, people may travel to other homes during the holiday season, or they may have guests visiting their home. Are there precautions you can offer to help keep everyone safe?

Mary Beth Dreyer: You know, that's a great question. And this time of year, this is something we talk over and over about. Holidays are a perfect time to visit loved ones. A lot of people travel during this time of year. And I would say, make sure your guests keep their purses and their suitcases or their little travel bags that might have medications in them up and out of sight. Give them a safe place to store their medications while they're visiting. Be sure that they're maybe in a bedroom, locked and out of sight. Um And people are using medication lock boxes for safe storage. That would be something that I would recommend using, too. It's just that extra level of protection that you could give your family and your guests while they're visiting.

Host Amber Smith: Now, I know the Upstate Poison Center serves Upstate New York, but if a family from here is traveling to Florida, and they have an issue that arises during their holiday, can they still call the 1-800-222-1222 number?

Mary Beth Dreyer: Absolutely. That is the same phone number wherever you are in the U.S. So it would just go to that local poison center. So yes, if you are out of town or you're staying in a hotel or you happen to be visiting relatives out state, it is the same phone number, that 1-800-222-1222.

Host Amber Smith: We've talked a lot about calling the poison center about children and unintentional injuries, but you get a ton of calls from adults about things that adults have done by accident or just have questions about if they're starting any medication, or if they bought something from the pharmacy and got home and it doesn't make sense to them.

Mary Beth Dreyer: Absolutely. I mean, most of our calls are about young children, children under 5. Those are where we get the majority of our calls. But we do get a fair amount of calls from adults that might be, like you said, on a new medication. They can't get ahold of their pharmacist. They can't get ahold of their doctor. So, you know, just for general information, people call us. Maybe some symptoms are happening that they haven't experienced before. I mean, we are medical experts, so, yes, adults do call us often for information, or for accidents that happen to them, too. Maybe they were cleaning in a closed area, and it's not ventilated. So they start feeling this dizziness or, again, if by calling us, we can help them avoid going to the ER. Obviously if there's an emergency, that's where you go. But if we can help people stay at home and help them at home, that would be, that's the ideal situation.

Host Amber Smith: Now, obviously the poison center is 24/7. So is the hospital emergency room. So how does a person decide whether to call or to go to the hospital emergency room immediately?

Mary Beth Dreyer: Again, I would say if somebody is losing or has lost consciousness, if they're having trouble breathing, if they're experiencing seizures, go to the ER. Call 911. It's best to just go right to the emergency room. But you know, if anything else is happening in your house, feel free to give us a call, whatever the issues are. You know, don't be embarrassed for the call. It's a free call, and we would just encourage people, call the experts. We're the poison center. We focus on poisonings, and we are well trained and ready and want people to give us a call.

Host Amber Smith: Now, how do you handle any phone calls the poison center receives about dogs or cats? Because I know this time of year, too, pets may be exposed unintentionally.

Mary Beth Dreyer: For sure. You think of traveling with your family, and oftentime your pet goes along with you. We do get a fair amount of calls regarding pets, but we focus on people and not animals. We could maybe give some advice to a caller, but we would encourage people to call their vet or the ASPCA Animal Poison hotline. And I have that phone number, I'd be happy to share. That is 888-426-4435. Again, that's the ASPCA Animal Poison hotline. And unlike the poison center, there is a charge for their calls. But again, they have experts that focus on our beloved pets.

Host Amber Smith: .Where would you suggest people go for more information on the topics we've been discussing?

Mary Beth Dreyer: I would encourage people to visit our website. And that's www.upstatepoison.org. We have lots of information about poison safety, about holiday safety. We have newsletters and videos that are applicable to all audiences. And if people want, they can get free information sent right to their home. We have stickers and magnets, medicine spoons. We have all sorts of products that are for free, so if people want to visit us on our website. If anybody has questions or concerns or needs information about maybe a new medication and they can't get ahold of their pharmacy, or their doctor's office is closed, I would certainly recommend people giving us a quick phone call.

Host Amber Smith: Well, thank you for making time for this interview, Mrs. Dreyer.

Mary Beth Dreyer: Oh, for sure. Thanks so much for having me.

Host Amber Smith: My guest has been Mary Beth Dreyer. She's a public health educator at the Upstate New York Poison Center. And again, the center can be reached 24 hours a day, seven days a week, at 1-800-222-1222. And the website is upstatepoison.org. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," a behavior analyst discusses resistance to change.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Today I'm talking about change with a researcher who studies behavioral analysis. Dr. Andy Craig is an assistant professor of pediatrics and also of neuroscience and physiology at Upstate, and he's the chair of behavior analysis studies at the Upstate Golisano Center for Special Needs.

Welcome to "HealthLink on Air," Dr. Craig.

Andy Craig, PhD: Thank you, Amber. It's such a pleasure to be here.

Host Amber Smith: Your recent paper in the Journal of the Experimental Analysis of Behavior starts with a couple of descriptions of behavior that persists even when challenged: a college student who continues studying despite invitations to go out with friends, a person at a bar who keeps drinking despite pleas from friends to stop.

So these are examples of "resistance to change," is that right?

Andy Craig, PhD: That's absolutely right, Amber. In behavioral psychology, we use the term "resistance to change" as a technical term to refer to how much a behavior keeps going or how much it persists despite the fact that there may be things in the environment that make it really difficult for that behavior to continue.

So we might have a college student who is vigorously working on their homework, and they have friends who are distracting them from that task. But despite those distractions, they may persist in doing their homework. They may completely stop doing their homework. They may do something in between. But how much their behavior persists is what we're talking about when we use the term resistance to change.

Host Amber Smith: So the person who's studying seems focused and unwilling to be distracted; they're engaged in what academics call a "pro-social behavior." The person at the bar is also locked into their behavior, but drinking to excess is socially undesirable. Did you choose these two examples because of those differences?

Andy Craig, PhD: I absolutely did. I think that it's important to understand that persistence in and of itself is not a good thing, and it's not a bad thing. It depends on the behavior that you're talking about, and it depends on the situation where that behavior's happening. If we are talking about, as you refer to them, pro-social behaviors or appropriate behaviors, things that are generally adaptive for an individual, like communication or engaging in academic work or living a healthy lifestyle, healthy eating, exercise. These are all behaviors that we would want to persist, or we would want to resist change whenever something in the environment otherwise disrupts them or prevents them from happening. But of course, on the other side of the coin, there are a whole host of other behaviors that we would consider maladaptive, or behaviors that may pose a risk to the individual.

As a behavioral psychologist, I intervene on these sorts of behaviors all the time, things like destructive behavior in children diagnosed with intellectual and developmental disabilities, perhaps substance-use disorders, problematic gambling. These are behaviors that throughout the course of treatment we're going to see them resist change, but our goal is to ultimately deter them from happening.

So I wanted to make sure that people who read this article and folks in the audience are aware that persistence is kind of a neutral concept. It really depends on the context in which you're talking about it.

Host Amber Smith: You say in the paper that there are a growing number of findings that challenge the basic tenets of behavioral momentum theory.

What is that theory, and what are the findings that challenge it?

Andy Craig, PhD: Behavioral momentum theory is a way that we behavioral psychologists have thought about persistence for, gee, it must be 40 years at this point. It was developed in 1983 by Tony Nevin (of the University of New Hampshire) and his colleagues. And getting into the nitty-gritty and the specifics of the theory can be challenging even for folks like myself, who have been working with the theory for quite some time.

But its broad, sweeping strokes are based on this typical finding that whenever we have a behavior that happens in two different contexts or two different settings, and those contexts or settings are associated with different conditions of reward or reinforcement, behavior is more likely to persist in a setting that is associated with more reward or more reinforcement.

So, just to bring this into a real-world example, let's say that we have a child who may transition in between classrooms as part of their academic day. In one classroom, they receive a lot of encouragement and a lot of reward and incentive for appropriate academic behavior. And in another classroom, they may receive less encouragement for appropriate academic behavior.

Now, if you were to introduce a disruptor in both of those classrooms, maybe they now have noisy classroom neighbors that prevent them from doing their schoolwork in the class. That behavior is more likely to persist in the classroom that's associated with more reinforcement. It's more likely to resist changes in that classroom.

So behavioral momentum theory argues that what makes behavior persist are the associations that we build between the context in which behavior occurs, so these classrooms, for example, and the reinforcers of the rewards that are delivered in those contexts. So in this example, the encouragement for appropriate academic behavior.

The second part of your question is also, I would say, kind of nuanced and sometimes difficult to understand even for folks who are within the field. But suffice it to say that behavioral momentum theory says that whenever you have a context that has more rewards, more reinforcers, in that context, behavior should be more persistent.

And that's simply not always the case. There are really, really specific situations where behavior may actually be less persistent in contexts that are associated with more reward. And what's surprising to me, someone who has studied this theory since I entered graduate school, is that we've known about these challenges since the development of the theory itself.

So the purpose of this paper was really to dive into and to better understand why we keep using a theory that we may understand at this point to be incorrect, or, even worse, wrong.

Host Amber Smith: Let me ask you about the reward: That's not necessarily a tangible prize, right? It could just be that you enjoy the environment you're in?

Andy Craig, PhD: Yeah, absolutely. And when you say that you enjoy the environment that you're in, there are probably components of that environment that make you enjoy it. That can be tangible things. I work in a behavior analysis clinic, and the universal tangible item for the kids that we work with is the iPad. Children nowadays love screens, right?

But it can be encouragement, it can be praise, it can be working on things that you find intrinsically reinforcing or intrinsically rewarding. Any of these outcomes that you as an individual enjoy make those contexts more rewarding.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Dr. Andy Craig from the Upstate Golisano Children's Hospital's Center for Special Needs about his research into human resistance to change.

Now, originally, I thought this was going to be about how people don't like change, but that's not really what it is. Or does it tie together to that?

Because a lot of people resist changing.

Andy Craig, PhD: That's a great question, Amber. And I think the answer to that question is that it's complicated. Unlike so many things in science and so many things when it comes to human behavior, the basic learning factors that make behavior persist will determine whether or not behavior changes.

Whenever something in the environment disrupts that behavior, and there are a whole host of other factors that may be associated with whether or not someone says that they embrace change or that they reject change. We humans are pretty risk averse. There have been behavioral economic studies that have compared an individual's choice of small, certain outcomes to much larger, probabilistic outcomes. So let's say a small amount of money that you get with 100% certainty and a much larger amount of money that you might get 50% of the time -- you have a 50-50 shot. That probability very strongly weighs in an individual's decision making.

Of course, there are individual differences with how strongly that association plays out.

Individuals who engage in problematic gambling, for example, are much more likely to pursue those risky options. But generally speaking, folks don't like to take risks. Folks don't like to be introduced into situations where we can't predict what happens next. And when things change in the environment, when rules change, when our jobs change or components of our jobs change, we can't really predict what's going to happen next, and that's definitely a component of whether or not someone embraces change or tries to fight against change.

Host Amber Smith: So are some people born more resistant to change than others?

Andy Craig, PhD: There are certainly subjective differences in how much of an individual's behavior will resist change.

Andy Craig, PhD: I work with both humans, in treatment populations and typically developing humans. I also work with non-human animals. I've done a lot of work with pigeons, rats, mice, and regardless of the species or the setting where I'm conducting my research, I find that some people's behavior is super-persistent, whereas other individuals' or other organisms' behavior may be much less persistent. And I think putting a finger on exactly why those individual differences exist is kind of tricky.

I don't doubt at all that there are probably some underlying genetic predispositions to make people maybe more or less sensitive to changes in their environment, more or less sensitive to reinforcers or rewards.

But it could also be learning factors. Often, whenever we are engaging in treatment with children who come into our clinic, or we're engaging in research with human populations, I have no idea what happened in an individual's history, what rewards or reinforcers they may have experienced in their history that may have contributed to the extent to which their behavior persists.

But what's important is that we arrange our treatments in such a way that we are programming for those treatment effects to maintain over time. So even if someone is born more or less persistent, there's stuff that we can do now to make behavior more or less persistent in the future.

Host Amber Smith: Let me ask you, as people age or as animals age, have you noticed, is there a change in their resistance to change?

Do they become more or less resistant as they get older?

Andy Craig, PhD: That's another fantastic question, Amber, and I don't have a scientific answer for you, but I'm taking notes (laughs) for my teacher research because that could certainly be an important question to answer.

I will note that there are changes across the lifespan that lead me to believe that there could be changes in how persistent someone is or how much they persist despite disruptions to their behavior.

For example, as someone ages from childhood to adolescence, and then from adolescence to adulthood, there are changes in a construct that we refer to as executive functioning. That's an individual's ability to modify their own behavior on a moment-to-moment basis and to take into consideration different sources of information when making split-second decisions.

It's also associated with someone's impulsivity or impulsive decision making, and generally speaking, as someone ages, they become less impulsive. They become more able to exert control over those in-the-moment decisions. And those in-the-moment decisions almost certainly have some bearing on whether or not an individual persists in engaging in a behavior that might not necessarily be working for them right now.

So I wouldn't be surprised if there were those associations. We haven't studied those just yet, though.

Host Amber Smith: Well, I'd like to hear how your study of behavioral momentum theory and resistance to change applies to your work at the Upstate Golisano Children's Hospital Center for Special Needs. Do you have a goal of working with these children to make them more or less resistant to change?

Andy Craig, PhD: We sure do. The Golisano Center for Special Needs is a multidisciplinary clinic that provides support services for families of children who have specialized needs, including physical disabilities, intellectual and developmental disabilities and behavioral concerns.

When a child presents at the center with perhaps a severe behavior disorder, meaning that they may engage in things like aggression or property destruction or self-injury, we implement treatments to reduce those behaviors.

So of course, we're butting heads with resistance to change right there because we're trying to change their behavior.

It's not something that's going to happen overnight, so their learning history will determine how quickly our treatments are able to make those modifications.

But another important component of our treatment is that it needs to maintain over time. We arrange these treatments in a clinical space. Ultimately, they need to affect the child out in the natural environment, in the school, in the home, in the community, in all aspects of their lives, if we are going to produce meaningful change for that child and their family.

So an awful lot of the research that we conduct at the center is specifically designed to evaluate how we can make our treatments better in terms of producing those great long-term outcomes, just like the really great short-term outcomes that we can produce here in the clinic.

Host Amber Smith: So how much do you depend on parents and teachers and other adults in that child's life to reinforce what you teach or work on when they're at the center?

Andy Craig, PhD: Other stakeholders in the care of our families are absolutely critical to the treatment process. What we're doing is not, it's not like a pill, right? We're not reaching into a child and clipping out parts of their behavioral repertoire that we don't want to see anymore. We're simply altering the environment to set them up for success.

We are introducing effective learning opportunities for these children that will support appropriate behavior and deter inappropriate behavior in the long term. And once the child meets their treatment goals, and we discharge, part of the process of discharge is ensuring that we train parents, we train other stakeholders in the care of these children to implement the kinds of reinforcement-based treatments that we develop here with which the children have a lot of success, so it's really a group effort.

Host Amber Smith: So do you use the same strategies if you're trying to change behavior that is something sort of small, versus something that's rather involved, or big? Is it the same strategy?

Andy Craig, PhD: Behavior analysis is a toolbox, so we have a host of different behavioral strategies that we can use to produce behavior change, whether that be a small, innocuous behavior or a really, really impactful, challenging behavior for a family.

At the very, most basic, level, we're using principles of reward to encourage good behaviors, or we withhold rewards whenever we want behaviors to go away. We teach children, we teach caregivers, to load reinforcers where you want to see behavior and to reduce reinforcers where you don't want to see behavior.

The exact treatment strategies that we arrive at are highly individually determined. We'll work with a family for several months to ensure that the treatment package that we end with is one that is exactly tailored to the needs of the specific client that we're working with.

And no two children are the same. No two behavioral concerns are the same. They might look exactly the same from the outside. We might have two different children who refuse to do schoolwork in a classroom setting, but exactly how best to arrange a treatment strategy to encourage appropriate academic work in both of those children might lead us in two very, very different directions, and those behaviors may be differentially severe. One child may be really responsive to treatment, the other child may not, but we meet the child where they are, and we arrange treatment strategies that are specifically tailored for their presentations.

Host Amber Smith: Well, Dr. Craig, thank you so much for taking time to tell us about your work.

Andy Craig, PhD: It was such a pleasure to speak with you, Amber. Thank you so much for having me.

Host Amber Smith: My guest has been Dr. Andy Craig, an assistant professor of pediatrics and also of neuroscience and physiology at Upstate, and he's the chair of behavioral analysis studies at the Upstate Golisano Center for Special Needs.

I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Gail Hosking gives us a playful look into both her refrigerator and her character in her poem "The Zen of My Refrigerator."

I love emptying the leftovers

like the rest of fresh mint

into my ice tea, or

the parsley in meatloaf

I hope will last more than one night.

You with a little bit of mashed potatoes,

me with the one sweet potato tucked

in the back of the vegetable drawer.

The last of steak sauce for flavor.

I love adding a tomato or two

in the dal on the stove, an old onion

dropped into the pot. It's my hope

you'll finish the pudding too or

the local asparagus with its feathery

foliage. I'm not one for a new beginning

every night. I'm more the one that first

has to witness space, those empty

trays to give myself permission

to add more. Only then can I

consider other possibilities.

I pour the remaining sparkling water

into my glass, then the rest of the white wine,

stirring a bit of breathing room for the spirit

like a painting we aren't done with yet

or an inhalation of delicious air.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," what to consider if you have an unruptured aneurysm in your brain. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.