심한 자해로 입원한 아동의 행동치료

Behavior Therapy for a Severely Self-injured Child

The authors report behavior therapy in a 5 year old midly retarded boy with severe selfinjurious behaviors, consisting of head banging, chin knocking, nail biting, ear traction and face clapping. Routine laboratory tests including nerve conduction velocity test, chromosomal study, thyroid function test, V.D.R.L., E.E.G. and urine ferric chloride test were carried out to rule out organic causes. No positive finding was noted in the above tests. Intelligence test showed mild mental retardation IQ and social maturation score was 2 years below for his chronologic age. The main reason and functions of the patient’ s self injurious behaviors was attenition getting from the adults, particularly his mother, who is immature, non nurturing and lacking basic child rearing skills. As for the management of self injurious behaviors, extinction and differential reinforcement methods including inattention, warning for time out and restraint, time out and physical restraint were utilized in a hierachical order according to patient，s response. Whenever self-injurious behavior stopped, positive reinforcement was given a few minutes later each time. In addition to behavioral method, play therapy and parental education for parenting skill were carried out to improve the mother-child relationship. The results were judged to be successful by the end of one month admission period. On discharge self injurious behavior was nearly extinct. And temper tantrum was easily controlled by firm verbal warning. Also the patient showed mardked improvement in peer relationship and was able to engage in age appropriate play and express his emotion appropriately.