Improvement of self-monitoring skills, reduction of behaviour disturbance and the dysexecutive syndrome: Comparison of response cost and a new programme of self-monitoring training

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Abstract
Impairment of executive functioning may impose particular neuropsychological constraints on the ability to learn. Some categories of behaviour disorder are secondary to the presence of the “dysexecutive syndrome”, particularly impairment in the ability for accurate self-monitoring. In these cases behaviour modification interventions using reinforcement and extinction methods may be unsuccessful. Response cost has been reported previously as one method which facilitates learning in such cases. However, there are practical difficulties that limit its use, or make practitioners reluctant to employ it. In this paper a case is described in which behaviour incompatible with rehabilitation was attributable to inaccuracies in self-monitoring. Two treatment methods were utilised. Whilst response cost was used successfully the results did not generalise to a second environment. A new programme of self-monitoring training was implemented to: teach inhibitory control in this environment; evolve an alternative method that overcomes some of the practical disadvantages of response cost; and incorporate features that make it more acceptable to practitioners. The strengths and weaknesses of both methods are discussed and suggestions made as to when either should be employed. Finally, the use of discriminatory time-out is discussed and compared with response cost and self-monitoring training.