All issues > Volume 33(5); 1990

Original Article

J Korean Pediatr Soc. 1990;33(5):585-597. Published online May 31, 1990.

Treatment of Self-Injurious Behavior Through Behavior Therapy.

Bo In Chung¹, Jong Soo Kim², Jae Seung Yang², Bong Sun Kang³

¹Department of Rehabilitation, Yonsei University, College of Health Science, Wonju, Korea
²Department of Pediatrics, Yonsei University, College of Health Science, Wonju, Korea
³Department of Psychiatry, Yonsei University, College of Health Science, Wonju, Korea

Received: September 9, 1989;  Accepted: November 8, 1989.

Abstract

Three-step guided compliance training and movement suppression time-out technique were used to treat desruptive, self-injurious, and aggressive behaviors in an 8-years old tuberous sclerosis with severe mental retardation. In compliance training, the child’s compliance behavior to verval and/or gestural demand was reinforced with edible and/or social reinforcers and the noncomplied demand was forcefully carried out through physical prompting. Movement suppression time-out was enforced whenever any of the 3 problem behaviors occurred. The types of time-out technique used in this study were chair time-out and floor time-out. The treatment procedure was divided into 2 phases. In phase I, only disruption was the target of treatment and aggression and self-injurious behavior(SIB) were ignored, while in phase II，all 3 behaviors were the target of treatment. For the sake of minimizing the joccurrence of SIB and maximizing the opportunity for positive reinforcement, an arm restraint was installed while sessions were careied out in the treatment room. The restraint device was removed in the play room and ward. However, self-restraint phenomenon was not observed in this child affter the restraint devece was removed. After the 3 problem behaviors were controlled to a stable and manageable level, token training and a differential reinforcement of other behaviors (DRO) technique were introduced, which, for the sake of facilitating maaintenance and generalization of treatment effect, were mostly practiced in the play room and ward, and ward, and at home after the child'x discharge from the hopital, The results of treatment were as follows: the mean occurrence of disurption, aggression, and SIB was 50, 5, and 116 times per 15 minutes respectively before trealment and .8，.l, and 3.0 times respectively after treatment. In the 4-month follow-up study at home, no disruption or aggression was observed and SIB only sparsely (.1 time per 15 minute). Generalization of treatment effect across behaviors and settings was studied. However, generalization was not observed either across behaviors or settings. This strongly indicates that the occurrence of the 3 target behaviors was conditioned on the installment of movement suppression time-out.

Keywords :Self-injurious behavior, Behavior therapy, Behavior modification