Although typically described in autistic, mentally retarded, and sensory-deprived individuals, motor stereotypies also occur in normal children. In this preliminary report, the behavior modification techniques of habit reversal and differential reinforcement of other behavior were evaluated as a therapeutic modality for the suppression of stereotypic movements in nonautistic subjects. Twelve children, ages 6 to 14 years, with physiologic stereotypies were treated using a standardized treatment protocol. Clinical outcomes were based on differences between assessments obtained at baseline and on telephone follow-up. Evaluation scales included measures of the frequency, intensity, interference, and number of stereotypies (Stereotypy Severity Scale motor portion and Stereotypy Linear Analog Scale) and assessment of global function (Child Global Assessment Scale and Stereotypy Severity Scale global portion). The results were correlated with the child's level of motivation and the number of treatment sessions. After a mean follow-up of 12.1 months, motor stereotypies showed significant improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale total score, P = .009 and P = .046, respectively. Both scales showed a relationship between the number of treatment sessions attended and a reduction in movements. The Child Global Assessment Scale also improved with therapy, but there was no correlation with the number of treatment sessions. Highly motivated patients had greater improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale scales compared with less motivated patients, but motivation had no impact on the Child Global Assessment Scale. The combined use of habit reversal and differential reinforcement of other behavior is beneficial in reducing motor stereotypies in nonautistic children.
We report the results of a ban on smoking in The Johns Hopkins Children's Center, Baltimore, Md, beginning in July 1987. A survey 6 months before and 6 months after implementation of the ban showed current smoking prevalences to be 15% and 13.8%, respectively. The percentage of smokers who smoked at work declined from 82% before the ban to 43% after the ban. After the ban, 66% of smokers and 93% of nonsmokers agreed that a hospital should be smoke free, while 43% and 83%, respectively, agreed with this statement before the ban. Systematic observations showed a decline from 53% of visitors and staff smoking in public areas 1 month before the ban to 0% smoking 6 months after the ban. Twenty-four-hour cigarette butt counts in elevator lobbies located well within the center dropped from 940 for an average day to 19 for an average day 6 months after the ban. Finally, measurement of environmental nicotine vapor showed a decline from a weekly average concentration of 13 micrograms/m3 of nicotine 1 month prior to the ban to 0.51 micrograms/m3 of nicotine 6 months after the ban in nine lobby lounges. The results suggest that a total ban on smoking in a hospital is feasible and effective in virtually eliminating public smoking.
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