GENERALITY AND SIDE EFFECTS OF OVERCORRECTION1

The effects and side effects of overcorrection for self-stimulatory behaviors of two children in a specialized day-care program were evaluated. For one child, a “hand” overcorrection procedure involving arm and hand exercises was introduced contingent upon inappropriate hand movements and later contingent upon inappropriate foot movements. After “hand” overcorrection was withdrawn for inappropriate foot movements, a “foot” overcorrection procedure involving foot and leg exercises was introduced contingent upon inappropriate foot movements. For a second child, the “hand” overcorrection procedure was introduced contingent upon inappropriate hand movements during a free-play period, and later contingent upon inappropriate vocalizations at naptime. “Hand” overcorrection was withdrawn and then re-introduced sequentially for both behaviors. Several concurrent behaviors were measured to assess multiple effects of treatment. Results for both children indicated the “hand” overcorrection procedure suppressed inappropriate hand movements and inappropriate behaviors that were topographically dissimilar. In addition, inverse relationships were observed between the second child's inappropriate hand movements and appropriate toy usage during free play and between his inappropriate vocalizations and inappropriate foot movements during naptime. Results suggest that overcorrection procedures that are effective for one behavior can be used to reduce the frequency of topographically different behaviors. This finding is discussed in terms of its practical implications for therapists.     

The trauma of attempted suicide

Suicide is a traumatic event, one which may acutely recreate a previously-experienced traumatic situation. The person's capacity to think after a failed suicide attempt is affected by the use of defence mechanisms against persecutory anxieties and depressive pain, and there is a wish to turn a blind eye to the seriousness of the suicidal act. This includes the damaging effects on the person's relationships with others, and damage to his own psychic integrity.

The need to turn a blind eye to the consequences of a failed suicide attempt may also be mirrored by the therapist who assesses and treats the patient in the early hours after such an event. Suicide is associated not only with the pain of despair but also with a ruthless abandonment of life. It is a complex and difficult task for a therapist in the immediate aftermath of a suicide attempt to be able to keep in mind a concept of suicide that includes both the patient's role as the perpetrator of great violence against himself, in which death is the intended outcome of his actions, and at the same time recognise the patient's identification with an abandoned and cruelly treated object.

In this paper, we describe some of the psychodynamic factors that affect and influence the assessment and treatment of patients in the immediate period following a failed suicide attempt. We emphasise the importance of supervision in helping prevent destructive acting-out by the therapist when treating disturbed patients under such painful circumstances.     

Obesity and intellectual disability

While much of the industrialized world struggles for clues to the growing rise in obesity in their respective countries, researchers and service providers involved in understanding the health characteristics and health behaviors of persons with intellectual disability (ID) struggle with their own issues regarding the increased prevalence of obesity in this segment of the population. What is particularly alarming is that adults with ID residing in the United States in smaller, less supervised settings (e.g., group homes and family households) have a significantly higher rate of obesity compared to other countries and those living in larger and more supervised settings (e.g., institutions). These differences support the theory that the environment appears to exert a powerful influence on obesity in this population. Obesity presents a substantial threat to the livelihood of persons with ID and may have an effect on community participation, independent living, and healthy years of life. The lack of research on successful weight reduction strategies for obese persons with ID makes this an important and greatly needed area of research.