Effect of a token economy behaviour therapy on drooling in children with cerebral palsy

Abstract

Objective: To investigate the effect of token economy-a behaviour therapy technique for controlling drooling in children with cerebral palsy associated with mild intellectual disability. Methodology: A total number of 25 children with cerebral palsy associated with mild intellectual disability attending the occupational therapy department of Swami Vivekanand National Institute of Rehabilitation Training and Research (SVNIRTAR), Orissa, India, participated in a single blind randomized pre-and post-test control group training study. Subjects were randomly allocated to group A (experimental n=12) and group B (control n=13). Baseline frequency of drooling was observed by two independent raters for 20 minutes for both the groups. After the baseline data collection, subjects in group A received conventional therapy along with behaviour therapy (token economy) and group B received conventional therapy alone. Results: The result showed that there was a significant decrease in frequency of drooling after application of token economy as a behaviour modification technique in the experimental group (P=0.001) as compared to the control group (P=0.070). Conclusion: The result of the study demonstrated that the token economy program was effective in controlling drooling in children with cerebral palsy associated with mild intellectual disability.

Behavioural interventions to treat drooling in children with neurodisability: a systematic review

“…Two studies described reduced drooling frequency. In the RCT, drooling frequency decreased significantly in the experimental group after token economy and positive reinforcement compared to the non‐experimental group ( p <0.01). In this study, the participants received a token (e.g.…”

“…Each study aimed to reduce a target behaviour related to either drooling frequency and/or severity. Frequency‐related outcomes in two studies included measures of drooling frequency and drooling drops per minute . Four studies assessed drooling‐severity related outcomes defined as percentage of chin wetness, percentage of wet time samples, pools of saliva, and drooling status .…”

“…In all studies, a combination of behavioural intervention methods was used, for example, prompting and reinforcement, rather than only a single method. Reinforcement was used in all eight studies, [32][33][34][35][36][37][38][39] with positive reinforcement in seven studies, [32][33][34][35][37][38][39] and token economy reinforcement in two studies. 32,37 Prompting was used in six studies.…”

“…Reinforcement was used in all eight studies, [32][33][34][35][36][37][38][39] with positive reinforcement in seven studies, [32][33][34][35][37][38][39] and token economy reinforcement in two studies. 32,37 Prompting was used in six studies. [33][34][35][36][37]39 Three of the studies used the term 'cueing' instead of 'prompt', in which a visual, auditory, or vibratory stimulus prompt was provided by an assistive technology device to make the correct response more likely, for example, swallowing, wiping the mouth [33][34][35] (see Table SI for behavioural intervention definitions).…”

Low-level evidence for behavioral intervention to treat drooling in children with neurodisability

“…Participants from the included studies in this review were treated in very different settings such as a public school (Kay et al, 2006), a special class in a regular school (Dunn et al, 1987), a nonresidential center for individuals with learning disabilities (Drabman et al, 1979), a research/treatment facility (Sethy et al, 2011), and a residential setting for individuals with multiple or severe/profound learning disabilities (Lancioni et al, 1989(Lancioni et al, , 2009a(Lancioni et al, , 2009bRichman & Kozlowski, 1977). It should be recognized that the learning abilities of participants in combination with setting characteristics determine which behavioral procedures and training intensity are appropriate and feasible.…”