Case study: Noninvasive behavioral treatment of self‐injurious hand stereotypy in a child with Rett syndrome

Abstract

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 Instruction alone did not maintain hand mouthing suppression when interruption was withdrawn, and treatment gains appeared highly discriminated.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 (DRI +I) to be superior to hand splints in reducing hand stereotypies, with approximately equivalent increases in collateral tongue thrusting.

Rehabilitation interventions in Rett syndrome: a scoping review

“…Fine motor rehabilitation interventions were conducted at rehabilitation facilities, 71–79 educational facilities, 65–68,80–84 and residential homes 64,70,85,86 . Two case series did not specify the location of the interventions 69,87 .…”

“…2 Operant conditioning and splinting in one case study improved fine motor function alongside standing abilities. 85 Furthermore, newly learned motor skills, such as eye-pointing, often enhanced communication abilities. 60 In select music therapy studies, instrument playing increased choice-making and vocal utterances, 72 and improvements in fine motor abilities facilitated the recognition of new words.…”

“…Fine motor rehabilitation interventions were conducted at rehabilitation facilities, [71][72][73][74][75][76][77][78][79] educational facilities, [65][66][67][68][80][81][82][83][84] and residential homes. 64,70,85,86 Two case series did not specify the location of the interventions. 69,87 Specific details regarding intervention intensity are available for 18 of 24 studies (Tables 2, S4, and S6).…”

Addressing the Needs of Students with Rett Syndrome

“…The most successful intervention for both of the children was differential reinforcement (reinforcement in the presence of one stimulus but not others) paired with response interruption. Paisey, Whitney, and Wainczak (1993) concluded that a combination of graduated guidance and social and edi-ble reinforcers successfully established stable rates of functional hand movements to activate toys, gross motor responses to verbal prompts, palm grasp and release, and some vocal imitation. Contingent response interruption virtually eliminated hand mouthing during instructional sessions.…”

Comparison of the presence and absence of an intervention to reduce hand stereotypies in individuals with Rett syndrome

“…Various upper extremity splints have been used as effective interventions, with 18 out of 21 participants across seven splinting studies experiencing a decrease in their stereotypic hand movements (Aron, 1990;Bumin et al, 2002;Kubas, 1992;Naganuma & Billingsley, 1988;Sharpe, 1992;Sharpe & Ottenbacher, 1990;Tuten & Miedaner, 1989). Gentle physical interruption of hand mouthing during play (Paisey et al, 1993), interactive game play (Watson et al, 1996), operant conditioning (Roane et al, 2001), music therapy (Go, 2007), attentional training (Fabio et al, 2011), assistive technologies (Stasolla et al, 2014(Stasolla et al, , 2015(Stasolla et al, , 2018(Stasolla et al, , 2019Stasolla & Caffo, 2013) and virtual reality intervention (Mraz et al, 2016) can also decrease stereotypies.…”