Behavioural treatment of the dysexecutive syndrome: Reduction of repetitive speech using response cost and cognitive overlearning

Publisher Website
Google Scholar
Abstract
Damage to the frontal lobes frequently precedes the development of behavioural disorders that may prevent an individual gaining access to rehabilitation services. In recent years the use of behaviour modification, particularly programmes based on the use of positive reinforcement and time-out, has been increasingly reported in the literature as a means of remediating behaviour disturbance. However, it is becoming clear that there is a subgroup of brain-injured individuals who do not respond to the use of such methods and who present with the “Dysexecutive Syndrome”, which imposes neuropsychological constraints on their ability to learn using these techniques. This study describes the use of two behavioural methods—response cost and cognitive overlearning—in the treatment of a behaviourally disturbed, herpes simplex encephalitis survivor who presented with a dysexecutive syndrome. Treatment resulted in significant statistical and clinical change within sessions. This change was found to have generalised and was maintained on the ward environment up to 3 months after the programme had been withdrawn. The validity of the use of these techniques, particularly response cost, in the treatment of patients who have the neuropsychological constraints imposed on learning by the dysexecutive syndrome are discussed. The use of response cost in the treatment of less cognitively damaged patients who present with behaviour disorders of very high frequency is also described.