Behavioral Interventions

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Volume 8 Issue 2 (April 1993), Pages fmi-fmi, 69-161

Case study: Noninvasive behavioral treatment of self‐injurious hand stereotypy in a child with Rett syndrome (pages 133-145)


Treatment of stereotypic hand mouthing in a 3‐year‐old girl with Rett syndrome by differential reinforcement of competing functional responses plus response interruption is described and evaluated in this case study. A package of graduated guidance with social and edible reinforcers successfully established stable rates of functional hand movements to activate toys, gross motor responses to verbal prompts, palmar grasp and release, and some vocal imitation. Contingent response interruption virtually eliminated hand mouthing during instructional sessions. Instruction alone did not maintain hand mouthing suppression when interruption was withdrawn, and treatment gains appeared highly discriminated. Post‐hoc comparison indicated differential reinforcement plus response interruption (DR1 + 1) to be superior to hand splints in reducing hand stereotypies, with approximately equivalent increases in collateral tongue thrusting.

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