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Virues‐Ortega J, Clayton K, Pérez‐Bustamante A, Gaerlan BFS, Fahmie TA. Functional analysis patterns of automatic reinforcement: A review and component analysis of treatment effects. J Appl Behav Anal 2022; 55:481-512. [DOI: 10.1002/jaba.900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Javier Virues‐Ortega
- Universidad Autónoma de Madrid Madrid Spain
- The University of Auckland Auckland New Zealand
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2
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Hirano D, Goto Y, Shoji H, Taniguchi T. Comparison of the presence and absence of an intervention to reduce hand stereotypies in individuals with Rett syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:607-622. [PMID: 34962025 DOI: 10.1111/jar.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated how many individuals with Rett syndrome were undergoing interventions to reduce stereotypic hand movements and the factors determining the presence or absence of an intervention. METHOD A questionnaire was sent to 194 families. Each survey item was compared between the intervention and non-intervention groups according to the presence or absence of interventions to reduce hand stereotypies. RESULTS Information was acquired from 72 cases; 72.1% of individuals had received an intervention to reduce stereotypies at some point in their lives. An upper limb splint was the most common intervention. Age, locomotor and reaching function, diagnostic age, frequency and type of stereotypy, joint contractures and stereotypy-associated problems separated the presence or absence of a current or past intervention. CONCLUSIONS Interventions for stereotypy-associated problems are important and there are several variables related to whether an intervention is received.
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Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Faculty of Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan.,Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Hiroaki Shoji
- Laboratory of Physiology, College of Education, Ibaraki University, Ibaraki, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan.,Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Japan
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Yang D, Robertson HL, Condliffe EG, Carter MT, Dewan T, Gnanakumar V. Rehabilitation therapies in Rett syndrome across the lifespan: A scoping review of human and animal studies. J Pediatr Rehabil Med 2021; 14:69-96. [PMID: 32894256 DOI: 10.3233/prm-200683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To perform a scoping review of the evidence for therapeutic interventions to manage functional impairments associated with Rett syndrome (RTT) throughout the lifespan. METHODS MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, Scopus and Index to Chiropractic Literature were searched systematically up to December 2019. Two investigators independently reviewed all search results and extracted those that met the inclusion criteria. Human and animal model studies pertaining to therapies that increase functional ability or treat RTT-associated symptoms in all age groups were included. Relevant studies were grouped into intervention categories and rated using the Oxford Centre of Evidence Based Medicine Levels of Evidence. Demographics of participants, interventions, and outcomes were summarized. RESULTS Ninety-one articles representing 88 studies met the inclusion criteria, of which 80 were human clinical studies and eight were studies using animal models. Study designs were primarily case series and only six studies involved participants above the age of 40. CONCLUSION A small number of rigorously studied rehabilitation interventions have been published. Published studies aim to address a wide variety of functional impairments. Research regarding implementation of therapies for older patients with RTT is lacking and requires further exploration.
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Affiliation(s)
- David Yang
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Helen Lee Robertson
- Liaison Librarian, Clinical Medicine, Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Elizabeth G Condliffe
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Melissa T Carter
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Vithya Gnanakumar
- Departments of Clinical Neurosciences and Pediatrics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Lim J, Greenspoon D, Hunt A, McAdam L. Rehabilitation interventions in Rett syndrome: a scoping review. Dev Med Child Neurol 2020; 62:906-916. [PMID: 32472972 DOI: 10.1111/dmcn.14565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
AIM To summarize existing interventions and their outcomes in Rett syndrome (RTT) rehabilitation and identify gaps in the literature. METHOD Five databases (Ovid MEDLINE, Ovid Embase Classic, Ovid PsycINFO, EBSCO CINAHL Plus, and ProQuest ERIC) were systematically searched up to 23rd July 2018 for studies describing rehabilitation interventions. Data on study participants, design, and outcomes were extracted. RESULTS Sixty-two articles were included in the final review. Evidence consistently demonstrated that females with RTT can improve their gross motor, fine motor, and communicative skills with rehabilitation. All 11 interventions targeting gross motor function, namely ambulation, achieved functional improvements. Twenty of 24 articles describing fine motor rehabilitation studies succeeded in decreasing stereotypies, improving functional hand use, and/or reducing self-injurious behaviors. Twenty-one of 22 studies describing communication interventions succeeded in training choice-making, communicative language, or socialization behavior. Other key findings include the positive interplay between physical and communicative rehabilitation outcomes, and the ability of females with RTT to improve their cognitive abilities during intervention. INTERPRETATION Rehabilitation can impact the daily lives of females with RTT and their caregivers in clinically meaningful ways.
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Affiliation(s)
- Jan Lim
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Anne Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Laura McAdam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Sigafoos J, O’Reilly MF, Ledbetter-Cho K, Lim N, Lancioni GE, Marschik PB. Addressing sequelae of developmental regression associated with developmental disabilities: A systematic review of behavioral and educational intervention studies. Neurosci Biobehav Rev 2019; 96:56-71. [DOI: 10.1016/j.neubiorev.2018.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
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Cianfaglione R, Meek A, Clarke A, Kerr M, Hastings RP, Felce D. Direct Observation of the Behaviour of Females with Rett Syndrome. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2016; 28:425-441. [PMID: 27340365 PMCID: PMC4875940 DOI: 10.1007/s10882-016-9478-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim was to observe the behaviour of a sample of females with RTT and explore how it was organized in relation to environmental events. Ten participants, all with a less severe form of classic (n = 9) or atypical (n = 1) Rett syndrome (RTT), were filmed at home and at school or day centre. Analysis used real-time data capture software. Observational categories distinguished engagement in social and non-social pursuits, hand stereotypies, self-injury and the receipt of attention from a parent, teacher or carer. Associations between participant behaviour and intake variables and receipt of attention were explored. Concurrent and lagged conditional probabilities between behavioural categories and receipt of attention were calculated. Receipt of adult attention was high. Engagement in activity using the hands was associated with a less severe condition and greater developmental age. Engagement in activity, whether using the hands or not, and social engagement were positively associated with receipt of support. The extent of hand stereotypies varied greatly across participants but was independent of environmental events. Six participants self-injured. There was some evidence that self-injury was related to adult attention. Participants appeared to experience a carer and attention rich environment and their levels of engagement seemed high as a result. As in the more general literature, engagement in activity was related to personal development and to social support. Self-injury contrasted with hand stereotypies in having possible environmental function.
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Affiliation(s)
- Rina Cianfaglione
- />Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, 2nd floor Hadyn Ellis Building, Maindy Road, Cardiff, Wales CF24 4HQ UK
| | - Andrea Meek
- />Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, 2nd floor Hadyn Ellis Building, Maindy Road, Cardiff, Wales CF24 4HQ UK
| | - Angus Clarke
- />Institute of Cancer & Genetics, Institute of Medical Genetics Building, Cardiff University, Heath Park, Cardiff, CF14 4XN UK
| | - Michael Kerr
- />Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, 2nd floor Hadyn Ellis Building, Maindy Road, Cardiff, Wales CF24 4HQ UK
| | - Richard P. Hastings
- />Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, CV4 7AL UK
| | - David Felce
- />Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, 2nd floor Hadyn Ellis Building, Maindy Road, Cardiff, Wales CF24 4HQ UK
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Heyvaert M, Saenen L, Maes B, Onghena P. Systematic Review of Restraint Interventions for Challenging Behaviour Among Persons with Intellectual Disabilities: Focus on Effectiveness in Single-Case Experiments. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 27:493-510. [DOI: 10.1111/jar.12094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Mieke Heyvaert
- Faculty of Psychology and Educational Sciences; KU Leuven; Leuven Belgium
| | - Lore Saenen
- Faculty of Psychology and Educational Sciences; KU Leuven; Leuven Belgium
| | - Bea Maes
- Faculty of Psychology and Educational Sciences; KU Leuven; Leuven Belgium
| | - Patrick Onghena
- Faculty of Psychology and Educational Sciences; KU Leuven; Leuven Belgium
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Fabio RA, Castelli I, Marchetti A, Antonietti A. Training communication abilities in Rett Syndrome through reading and writing. Front Psychol 2013; 4:911. [PMID: 24367345 PMCID: PMC3854542 DOI: 10.3389/fpsyg.2013.00911] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/16/2013] [Indexed: 01/28/2023] Open
Abstract
The goal of this clinical case study is to investigate the possibility of training communication abilities in people with Rett Syndrome (RS). Usually, girls with RS never exceed the sensorimotor stage of development, but the inter-individual variability typical of RS may lead us to doubt the irrevocability of that developmental limit, especially for those girls who are engaged in cognitive rehabilitation. The case study reported here concerns a 21-year-old girl with RS who was engaged in cognitive rehabilitation training based upon the principles of Feuerstein's modificability and mediated learning theory. The training aimed to teach her basic concepts and enhance reading-writing abilities. Statistical analyses showed that the girl reached adequate reading-writing abilities, proving the validity of the cognitive intervention which allowed her to communicate by composing words with her forefinger on an alphabetic table. Although these results need to be cautiously considered as they derive from a single case study, they have implications for future cognitive rehabilitation for deeply impaired clinical conditions as in the case of RS.
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Affiliation(s)
- Rosa Angela Fabio
- Department of Cognitive Science and Education, University of Messina Messina, Italy
| | - Ilaria Castelli
- Research Unit on Theory of Mind, Department of Psychology, Catholic University of the Sacred Heart Milan, Italy
| | - Antonella Marchetti
- Research Unit on Theory of Mind, Department of Psychology, Catholic University of the Sacred Heart Milan, Italy
| | - Alessandro Antonietti
- Service of Learning and Education Psychology, Department of Psychology, Catholic University of the Sacred Heart Milan, Italy
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Wanzek M, Jenson WR, Houlihan D. Recognizing and treating Rett syndrome in schools. SCHOOL PSYCHOLOGY INTERNATIONAL 2011. [DOI: 10.1177/0143034311403058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the literature on Rett syndrome (RS) for school-based professionals is presented from a behavioral perspective. A description of RS is provided, including distinctive physical, behavioral, and emotional features, diagnostic criteria for classic and formes frustes forms of RS, and stages of the disorder. The similarities and differences between RS and autism are reviewed. Controversies regarding the classification of RS are presented, including whether RS should be classified as a neurological or psychiatric condition and whether RS should remain classified as a pervasive developmental disorder. Last, a variety of options for the treatment of RS are discussed.
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Tunnicliffe P, Oliver C. Phenotype-environment interactions in genetic syndromes associated with severe or profound intellectual disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:404-418. [PMID: 21257289 DOI: 10.1016/j.ridd.2010.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 05/30/2023]
Abstract
The research literature notes both biological and operant theories of behavior disorder in individuals with intellectual disabilities. These two theories of genetic predisposition and operant reinforcement remain quite distinct; neither theory on its own is sufficient to explain challenging behavior in genetic syndromes and an integrated approach is required. This literature review integrates the two approaches by exploring how environmental factors can influence problem behavior in genetic syndromes associated with intellectual disability. Particular attention is paid to studies that describe evidence that problem behaviors in syndromes that are considered to be phenotypic are associated with other aspects of an established behavioral phenotype. The review highlights how the study of phenotype-environment interactions within syndromes can promote understanding of the aetiology of problem behaviors both within genetic syndromes and, ultimately, the wider population of individuals with severe intellectual disabilities. The review also evaluates the current status of research and the methods typically employed. Implications for intervention, future research and extending existing causal models of challenging behavior are discussed.
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Affiliation(s)
- Penny Tunnicliffe
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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Carter P, Downs J, Bebbington A, Williams S, Jacoby P, Kaufmann WE, Leonard H. Stereotypical hand movements in 144 subjects with Rett syndrome from the population-based Australian database. Mov Disord 2010; 25:282-8. [PMID: 19908321 DOI: 10.1002/mds.22851] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Stereotypic hand movements are a feature of Rett Syndrome but few studies have observed their nature systematically. Video data in familiar settings were obtained on subjects (n = 144) identified from an Australian population-based database. Hand stereotypies were demonstrated by most subjects (94.4%), 15 categories were observed and midline wringing was seen in approximately 60% of subjects. There was a median of two stereotypies per subject but this number decreased with age. Clapping and mouthing of hands were more prevalent in girls younger than 8 years and wringing was more prevalent in women 19 years or older. Clapping was commoner in those with p.R306C and early truncating mutations, and much rarer in those with p.R106W, p.R270X, p.R168X, and p.R255X. Stereotypies tended to be less frequent in those with more severe mutations. Otherwise, there were no clear relationships between our categories of stereotypies and mutation. Approximately a quarter each had predominantly right and left handed stereotypies and for the remaining half, no clear laterality was seen. Results were similar for all cases and when restricted to those with a pathogenic mutation. Hand stereotypies changed with increasing age but limited relationships with MECP2 mutations were identified.
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Affiliation(s)
- Philippa Carter
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Western Australia
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12
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Langthorne P, McGill P, O'Reilly M. Incorporating "motivation" into the functional analysis of challenging behavior: on the interactive and integrative potential of the motivating operation. Behav Modif 2007; 31:466-87. [PMID: 17548541 DOI: 10.1177/0145445506298424] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sensitivity theory attempts to account for the variability often observed in challenging behavior by recourse to the "aberrant motivation" of people with intellectual and developmental disabilities. In this article, we suggest that a functional analysis based on environmental (challenging environments) and biological (challenging needs) motivating operations provides a more parsimonious and empirically grounded account of challenging behavior than that proposed by sensitivity theory. It is argued that the concept of the motivating operation provides a means of integrating diverse strands of research without the undue inference of mentalistic constructs. An integrated model of challenging behavior is proposed, one that remains compatible with the central tenets of functional analysis.
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Cannella HI, O'Reilly MF, Lancioni GE. Treatment of hand mouthing in individuals with severe to profound developmental disabilities: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2006; 27:529-44. [PMID: 16188422 DOI: 10.1016/j.ridd.2005.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2005] [Revised: 05/27/2005] [Accepted: 06/02/2005] [Indexed: 05/04/2023]
Abstract
This paper reviews studies investigating the assessment and treatment of hand mouthing in individuals with severe to profound developmental disabilities. A literature search identified 101 studies carried out between 1969 and 2004. The trend in the studies indicated a shift away from aversive interventions in the last 10 years, so this review included studies conducted from 1995. Twenty-three studies were identified within this period and were included in this review. The 23 studies were sorted into seven intervention categories and one assessment category. The seven intervention categories included (a) antecedent interventions, (b) multicomponent interventions (e.g., differential reinforcement and response effort), (c) pharmacological interventions, (d) interventions that utilized reinforcement, (e) response blocking interventions, (f) response effort interventions, and (g) sensory stimulation interventions. The one assessment category included studies that investigated the function of hand mouthing. One main finding in these studies was that the various intervention strategies led to decreases in hand mouthing in individuals with severe to profound developmental disabilities. This finding is discussed in relation to its effect on issues of health, adaptive behavior, and social functioning. A second finding indicated that hand mouthing is often maintained by automatic reinforcement (i.e., non-social contingencies). The implications of this finding are discussed in terms of how assessments and treatments associated with automatically maintained challenging behavior might be more effectively linked. Potential issues for future research are also examined.
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Affiliation(s)
- Helen I Cannella
- George I Sanchez Building, Room 306, 1 University Station (D5300), The University of Texas at Austin, Austin, TX 78712, USA.
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Wales L, Charman T, Mount RH. An analogue assessment of repetitive hand behaviours in girls and young women with Rett syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:672-678. [PMID: 15357687 DOI: 10.1111/j.1365-2788.2003.00590.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Rett syndrome is a neurodevelopmental disorder that almost exclusively affects females. In addition to neurodevelopmental regression and loss of hand skills, apraxia, deceleration of head growth, and increasing spasticity and scoliosis, a number of behavioural features are also seen, including stereotypic hand movements, hyperventilation and breath holding. The aim of the study was to investigate the extent to which analogue environmental conditions affected the frequency of repetitive hand behaviour in eight girls and young women with Rett syndrome. METHOD The frequency of repetitive hand movements was observed every 10 s for four 4-min sessions under the following conditions: Continuous Adult Attention, Adult Demands, Stimulation and No Stimulation. RESULTS The frequency of repetitive hand movements was high -- they occurred in above 60% of all intervals in all conditions for all participants and at nearly 100% for some participants in some conditions. For one participant the frequency of repetitive hand movements was somewhat reduced in the Stimulation condition; for another it was relatively increased in the No Stimulation condition. CONCLUSIONS Overall, environmental manipulations had relatively limited effects on repetitive hand behaviours. Repetitive hand behaviour in Rett syndrome may be maintained by automatic reinforcement or neurochemical processes and may not be primarily influenced by contingent reinforcement.
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Affiliation(s)
- L Wales
- St. Margaret's School, The Children's Trust, Tadworth, Surrey, UK.
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