Williams D E, Kirkpatrick-Sanchez S, Crocker W T
Behavioral Services Division, Richmond State School, TX 77469.
Res Dev Disabil. 1994 Nov-Dec;15(6):487-501. doi: 10.1016/0891-4222(94)90031-0.
One of the shortcomings in the literature is the paucity of long-term follow-up reports of the treatment of self-injury and other destructive behavior, particularly of treatment involving contingent shock. This is a report of a long-term follow-up of treatment for a woman with severe mental retardation and severe self-injurious behavior (SIB) treated initially with the Self-Injurious Behavior Inhibiting System (SIBIS) in brief clinical trials. Programmed generalization and maintenance procedures consisted of treatment throughout all waking hours in all settings as well as during brief sessions. Significant reductions attained in the SIBIS clinical trials generalized to the natural environment and the brief follow-up sessions; however, rates began to climb in the natural environment until a SIBIS pairing procedure could be applied more consistently as a consequence of self-injury. Contingent shock was discontinued after month 30 of follow-up. Overall rates of SIB episodes in the natural environment were reduced from an average of 24.6 per month in the 7 months prior to the SIBIS clinical trials to less than 2 per month during the 72 months of follow-up. Rates in brief treatment sessions remained low during the entire follow-up period. Implications of these results are discussed.
文献中的一个不足之处是，关于自我伤害及其他破坏性行为治疗的长期随访报告匮乏，尤其是涉及偶发电击治疗的报告。本文报告了一名重度智力障碍且有严重自我伤害行为（SIB）的女性患者的长期随访情况。该患者最初在简短临床试验中接受了自我伤害行为抑制系统（SIBIS）治疗。程序化的泛化和维持程序包括在所有清醒时间、所有环境以及简短疗程中进行治疗。在SIBIS临床试验中取得的显著减少在自然环境和简短随访疗程中得以泛化；然而，在自然环境中，发生率开始攀升，直到由于自我伤害而能够更持续地应用SIBIS配对程序。在随访第30个月后停止了偶发电击。自然环境中SIB发作的总体发生率从SIBIS临床试验前7个月的平均每月24.6次降至随访72个月期间的每月少于2次。在整个随访期间，简短治疗疗程中的发生率一直较低。本文讨论了这些结果的意义。
