Treatment package to reduce SIB in a Lesch-Nyhan patient.

Self-destructive behaviour in LNS children results in a tremendous burden to parents, teachers, staff members, and other responsible for their care. As constant vigilance is not always feasible, developing alternate methods of managing SIB becomes imperative. This report presents our efforts to improve the care of an LNS child and to ease the burden on staff members and parents by obtaining special devices (e.g. the custom-made mouthguard and the gloves) to prevent him from injuring himself. Others (e.g. Letts & Hobson, 1975) have likewise reported success in fabricating custom-designed chairs and devices in an effort to manage SIB in LNS children. Their devices were, however, more elaborate and much more expensive than the ones used in this report. The cost of obtaining a mouthguard similar to the one used with K. is estimated at between $20-$30 (US), while the gloves cost only $14.00. The major advantages of using such devices are that they safely allow employment of the extinction procedure along with allowing the child to participate more fully in activities of daily living. It is recognized that K. was in some ways an atypical Lesch-Nyhan child in that he possessed low normal receptive intelligence and scored fairly high (relative to most LNS children) on a test of verbal intelligence. His cognitive and verbal abilities made him a unique case in that he responded favourably to therapeutic instructions regarding relaxation and self-control tactics. The therapists were able to rely on K.'s verbalizations and feelings about his biting in structuring the treatment approach.(ABSTRACT TRUNCATED AT 250 WORDS)