A descriptive analysis of studies on behavioural treatment of drooling (1970–2005)

Abstract

A descriptive analysis was conducted on studies on the behavioural treatment of drooling (published between 1970 and 2005). The 17 articles that met the inclusion criteria described 53 participants (mean age 14y 7mo, [SD 4y 9mo]; range 6‐28y). Sex of 87% of the participants was reported: 28 male, 18 female. For 60% of the participants the degree of learning disability was reported, varying from severe/profound (n=24, 75%), moderate (n=4, 13%), to mild (n=2, 6%), while two participants (6%) had no learning disabilities. Forty‐two participants (79%) were diagnosed with cerebral palsy. Behavioural procedures included instruction, positive and negative reinforcement, overcorrection and restitution, verbal and automatic cueing, and/or self‐management. Effective behavioural procedures are reported in children with and without learning disability and/or motor impairment. Even participants with profound learning disability may benefit from behavioural intervention. However, the evidence base in terms of number of studies in this area is limited. Fifteen studies used a single participant design; two studies implemented an experimental‐comparison group design. Some of these studies were poorly designed and methodological flaws were identified. Therefore, conclusions about efficacy of behaviour therapy for drooling and/or best practice cannot be drawn, although our analysis suggests that this approach is promising. However, future research on this topic is needed. After years of research focused on medical treatment, the option of behavioural treatment to reduce drooling should be reconsidered in relation to the medical management of this problem.

Randomized Phase III evaluation of the efficacy and safety of a novel glycopyrrolate oral solution for the management of chronic severe drooling in children with cerebral palsy or other neurologic conditions

“…Treatment options explored to control drooling in children and adults include behavioral approaches, such as prompts to swallow or wipe12 or preventing individuals from putting their fingers or objects into their mouths;13 surgery to decrease salivary flow,14 intraglandular injection of botulinum toxin type A,15,16 and anticholinergic agents such as benztropine, glycopyrrolate, trihexyphenidyl hydrochloride, and scopolamine patches 11,17…”

Self-management treatment of drooling: A case series

“…Behavioral treatment for drooling is an option that may be considered in relation to the advantages and disadvantages of oral motor therapy and related training with oral appliances, medication, Botulinum Toxin type A injections and surgery (Van der Burg et al, 2007a, 2007b. Although the present study shows promising results for a self-management procedure, it needs further adaptations to improve efficacy, generalization, and maintenance.…”

“…Although behavioral treatment is frequently advocated as a treatment option (e.g., Blasco, 2002;Brei, 2003), its evidence-base is limited (see Van der Burg, Didden, Jongerius, & Rotteveel, 2007a). In contrast to medical intervention studies on the treatment of drooling, the total number of participants in behavioral studies is small (i.e., N < 60) and participants vary considerably in age, and intellectual and motor disabilities.…”

Evaluation of glycopyrrolate in the treatment of chronic drooling

“…Behavioral approaches include the use of verbal, auditory, or vibratory prompts to swallow or wipe, 8 and prevention of mouthing of fingers or objects. 9 Botulinum toxin injected into the salivary glands, usually under ultrasound guidance, is effective in the management of drooling, but the effects wear off after a period of time.…”