title: Ethical issues involved in the implementation of a differential reinforcement of inappropriate behaviour programme for the treatment of social isolation and ritualistic behaviour in an individual with intellectual disabilities.
abstract: The present case study describes an adult male with a 28-year history of institutional care underpinned by a moderate intellectual disability (ID), and ritualistic behaviour congruent with features of autism or obsessive-compulsive disorder. The subject's ID was recognized early in life and he was provided with a special educational placement at 6 years of age, although his increasingly disturbed behaviour had resulted in several psychiatric admissions by early adolescence, and by the age of 20, his presentation necessitated long-term secure psychiatric care. The present report describes the application and ethical issues pertaining to a differential reinforcement of inappropriate behaviour (DRI) programme for the reduction of ritualistic behaviour and social isolation, the latter being a direct consequence of the former, one year after the subject was admitted to a medium-secure assessment and treatment residential facility. The results suggest that, although the treatment was successful in targeting ritualization and reducing social isolation, ethical concerns extended to care staff concerns about the reinforcer adopted for the programme and the lack of informed consent from the subject. The former resulted in inconsistent application of the programme and its eventual termination. A follow-up assessment of the subject's extent of social isolation and ritualistic behaviour suggested a return to a pre-DRI level of morbidity. Limitations and suggestions for the future treatment of such cases are outlined.
authors.affiliation: School of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Iqbal
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001321:Autistic Disorder / Q000523:psychology / Q000628:therapy*; D032763:Behavior Control; D001521:Behavior Therapy; D004401:Dysarthria / Q000523:psychology; D004989:Ethics; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D008297:Male; D009770:Obsessive Behavior / Q000523:psychology / Q000628:therapy*; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D012054:Reinforcement, Psychology; D012934:Social Isolation / Q000523:psychology*; D013997:Time Factors; D014754:Violence / Q000523:psychology