Monographs of the American Association on Mental Deficiency (1982)最新文献

This paper reports the effects of several environmental variables on the management and maintenance of a treatment program for self-injurious behavior (SIB) in residents in a state facility for retarded persons. Fifteen of the clients who participated in a developmental day-care program were compared across the final four months of the program and then at follow-up two years later. Twelve additional clients who were treated in the overall SIB program did not receive the day-care component, but were included in the follow-up study. Regarding program management, the effects of time, staff-initiated interactions, the presence of a newcomer or disruptive client, and medication changes on the behaviors of the 15 clients in the day-care program were assessed from an ecobehavioral approach. Participants in the follow-up study were compared with respect to the type of SIB program they received, the staff-patient ratio in their program, their visual impairment, use of self-protective devices, presence of stimulating material, and time-of-day observed. These issues are discussed in relation to program maintenance.

Chronic vomiting, in the absence of discernible physical illness, is a problem sometimes seen in individuals labeled as mentally retarded or mentally ill. This behavior often becomes life-threatening, particularly when it occurs in young children. Over the decades several theoretical analyses have been made of this behavior, and a wide range of treatments have been developed. This paper is a summarization of current and historical literature related to three types of chronic vomiting: (1) rumination in the infant; (2) rumination in the older child and adult; and (3) psychogenic vomiting. Treatment strategies are reviewed in some detail and are evaluated for the practitioner using effectiveness and efficiency as the main evaluative criteria. Several ideas for further research and theoretical analysis are also suggested.

Sixteen severely self-injurious residents of a state mental retardation facility were treated with conventional, non-aversive behavior modification techniques by the same staff over a four-year period. Although each resident had performed multiple self-injuries prior to treatment, including blindness, multiple permanent scars, punctured eardrums, etc., 12 of the 16 improved in terms of decreased frequency of self-injurious behavior (SIB) and decreased frequency of measurable physical injury; of these, seven ceased SIB altogether. Each resident's treatment was unique, which necessitated unique analyses of controlling antecedents and maintaining consequences. Two exclusive types of self-injurious residents became evident: a) those whose SIB was maintained by socially reinforcing consequences and b) those whose SIB was maintained by escape contingencies. The study suggests that in agencies where intensely aversive techniques cannot be used to treat SIB, occasional restraint control of behavior can be combined with intensive differential reinforcement of other (DRO) or incompatible (DRI) behavior to produce an extended but satisfactory probability of successful treatment. Similar to published results from intensely aversive treatment, mildly aversive treatment, which largely depended upon positive reinforcement of desirable alternative behaviors, did not completely suppress the most severe SIB.