Modifying adult interactional style as positive behavioural intervention for a child with Rett syndrome

Abstract

A naturalistic behavioural assessment and intervention program over a 3-year period for a girl with Rett syndrome is described. Using real-time, multiple response measurement, the relationships among various excess behaviours and environmental conditions were observed. Initial attempts to teach a voluntary manual response and an explicit communicative response were unsuccessful, and when teachers physically interrupted her hand stereotypies it resulted in a reciprocal increase in other excess behaviours. Since the child's mannerisms were exacerbated by demanding instructional conditions, the revised intervention involved playful, complementary interactions with her teacher, as well as a continuation of a structured program to teach a voluntary response. After a further year of instruction, the child produced a minimal number of manual responses. The most significant reduction in hand mannerisms, as well as other excess behaviours, was related to positive social interactions and play that allowed for communication at the affective level. The study demonstrates that the frequency of the stereotypic behaviours characteristic of Rett syndrome can be influenced by environmental contingencies, but that teaching alternative, manual behaviours is likely to be less productive than focusing on whatever communicative behaviours are present in the repertoire.