A case study in the remediation of severe self-destructive behavior in a 6-year-old mentally retarded girl
✍ Scribed by Gerald Rubin; Karen Griswald; Ira Smith; Concetta de Leonardo
- Publisher
- John Wiley and Sons
- Year
- 1972
- Tongue
- English
- Weight
- 283 KB
- Volume
- 28
- Category
- Article
- ISSN
- 0021-9762
No coin nor oath required. For personal study only.
✦ Synopsis
Susan was 5 years old a t the time of her first admission t o the Dr. Joseph H. Ladd School for the retarded, but her behavioral syndrome had been present to some degree since 9 months of age, when i t first became severe enough t o be of concern to her parents. Prior to that time there was no apparent symptomatology t o indicate the presence of mental retardation or autism. It was only after the sudden loss of her close association with her grandmother that Susan began to display a type of autistic withdrawal and noncommunicativeness with others. Her condition deteriorated until life consisted of nightly and eventuaIly daily restraint in order t o prevent self-destructiveness that might have resulted in the child's death.
When the first author initially met Susan a t age 6, her face was completely scabbed and scarred, some of her teeth had been knocked out, she constantly cried, and she rejected entirely the presence of anyone except one attendant to whom she clung obsessively. It was from these bare circumstances that our work had to begin.
The first step with Susan was to consider her behavior in terms of a hierarchy of pleasant to unpleasant activities that already were present in her life space, however restricted in number they might be. After it was determined that the attendant was the most positive aspect of Susan's life, the author began to make weekly visits with Susan and her attendant friend to a field where we played kickball, one of the few activities in which Susan would allow herself t o be passively engaged. The favorite attendant and the author always were present a t these times. Our efforts further were oriented toward the creation of a ritual from these trips to the field. This procedure was employed, of course, because of Susan's strong compulsive tendencies; there was every reason to employ this aspect of her personality to her advantage rather than to destroy her one slim contact with the outside world. That is, we simply tried t o increase the number of rituals in Susan's repertoire so as to enhance her contacts with the world and waited for a later stage of her improvement and development to be concerned about their spontaneity.
For 2 months the attendant and the author disregarded Susan's crying and self-destructive outbursts and played kickball. On occasion we diversified our program and took Susan for a walk, and at these times Susan was much more relaxed and behaved with far fewer self-destructive and crying outbursts than during any other activities in which she engaged herself with us. It was a t this point that the first author was granted permission to work at least 2 hours each day with Susan.
From this time onward, the author worked with Susan with minimal assistance from the attendant. Susan's behavior a t this time fluctuated between severe selfbeatings, continuous crying and, by way of contrast, some small recognition of the investigator's entrance into her hospital room. Whenever Susan's crying would become excessive even by her standards, the author would walk out of the room and stand just outside the doorway. Susan would look in that direction and would stop crying and beating until the investigator would return. If she began to cry