Psychological treatment

There are a range of behaviour-modification techniques based on operant conditioning principles that are effective in promoting positive behaviours and reducing difficult behaviours. Analysis of the possible function of the behaviour and changing the antecedent trigger events and environmental context such as removal of an upsetting sound or providing attention, may eliminate the behaviour.(76) Appropriate behaviour can be rewarded. In young people with sufficient ability to understand consequences, a reward can be provided when a period of time, for example a day, passes without the occurrence of the undesired behaviour such as biting. Another strategy is the avoidance of responses to the behaviour which might act as a contingent reward, perhaps coupled with an undesired, but non-aversive consequence. For example instead of taking a child outside into their favourite garden every time they scream, they might be ignored or put in a time-out corner. Disruptive behaviour may also have a communicative purpose and attempts to understand this and provide more adaptive methods of communication such as the use of signing or pictures may be therapeutic. (18>

Modified cognitive therapy taking into account the level of verbal ability of the child, and teaching progressive muscle relaxation and breathing techniques with demonstration and imitation, may reduce anxiety and depression, ( ) although the effectiveness of these approaches in children with mental retardation has still to be fully established. Psychological approaches to treatment and counselling of children with mental retardation requires the therapist to be mindful of the developmental level of the child and ensure that the language used is comprehensible and that their approach is supportive and encouraging.

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