Sleeping difficulties are relatively common amongst normal young children at some stage in their development. It is estimated, for example, that approximately 20% of normal 1–2 year olds and 14% of 3 year olds wake regularly during the night (Bernal, 1973; Jenkins, Bax and Hart and Land-sown, 1980). Amongst handicapped children rates of sleeping disturbance tend to be even higher (Richman, Stevenson and Graham, 1975; Richman, Douglas, Hunt, Levere, 1982) and in autistic children, in particular sleeping difficulties are frequently severe and persistent. Thus, De Meyer (1979) found that almost all autistic children had shown sleeping problems at some stage in their development and at an average age of 5½ years, 49% still showed severe sleeping difficulties (as compared with only 3% of normal controls). This additional strain on parents, who already have to cope with many behavioural problems throughout the day, can be considerable, and frequently has a deleterious effect on many aspects of family and marital relationships.

A 50-year-old married woman who had had a radical mastectomy was on the threshold of ceasing to take adjuvant chemotherapy because of a longstanding needle and blood phobia and a recently acquired conditioned nausea response to hospital and medical situations. A cognitive-behavioural therapy programme incorporating relaxation training, imaginal systematic densitization and video modelling, allowed her to complete the chemotherapy course and to feel less anxious in hospital and medical settings.

This study was carried out in a residential school for 46 junior boys ascertained as maladjusted. Some of the dissatisfactions with the more conventional classroom based economies are expressed and the “Levelled Economy” is put forward as an alternative model. The levelled system is described in detail and the economy evaluated over a 3-month period. The results showed a dramatic reduction of inappropriate behaviour and also a large increase in the acquisition of skills.

Social dysfunction in a 45-year-old man was treated by a combination of exposure in vivo, social skills training and cognitive modification. Social skills training utilized broad conversational targets designed to help the patient to engage flexibly in social interactions and to be able to generate them in order to achieve his personal goals: to expand and increase his social contacts and meet the opposite sex.

Change was assessed on the basis of the patient's records of daily frequency of performance of targeted behaviours and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact.

The intervention resulted in an increased performance of social targets in real life, general social activity, and a related decrease in associated anxiety. The outcome was maintained for an available 1 year follow-up; systematic data collection was stopped after 6 months. A general improvement in the patient's personal, social and vocational life has also occurred.

A profoundly mentally handicapped woman was reported to be a major management problem for staff in the residential home where she lived, especially at mealtimes. Following a constructional approach the subject's appropriate behaviour was targeted. A multiple baseline design with reversal was used to investigate the effects of a contingent contact procedure on the subject's level of engagement. Results showed the procedure to be effective in increasing the amount of time the subject spent engaged in appropriate mealtime behaviour. Continuing problem behaviour at other times of day is discussed within the context of the overall living environment.

A treatment approach to severe, refractory obesity involving combining therapeutic starvation with behavioural management techniques was advocated. The potential of the approach was illustrated by the description of a patient who lost 53 lb in weight over a 14-month-period.

This case study explores the therapeutic usefulness of self-exposure instructions by telephone. With very little contact (2 h 20 min over 11 weeks), the agoraphobic client made considerable progress in traveling by bus and shopping in crowded stores. As he lived a considerable distance from the hospital and could not have attended for regular out-patient sessions, a home-based programme would have been the only other alternative. This would have been much less cost-effective.

This paper describes the successful application of a behavioural intervention to the inappropriate behaviour of a severely mentally handicapped hospital resident. The intervention was based on the Constructional approach and at sixth week follow-up the effects had been maintained. Furthermore, there was evidence that these had generalised to other behaviours. Significant changes were noted in the attitudes of direct care staff and it is suggested that these may have been attributable to the nature of the approach used. The Constructional approach was considered ethically and practically superior to alternatives which would have concentrated alone on reducing or removing behaviour in the client's limited repertoire.

Current evidence supports the effectiveness of behavioural methods in the treatment of trichotillomania (compulsive hair-pulling). In particular, the Habit Reversal Method has been demonstrated to be effective. Some discussion has centred on defining the active components of this “package” and whether it is applicable to all clients. This case study reports on the successful use of the method to treat a 19-year-old female. Treatment produced an immediate reduction in the number of hairs pulled out, although the client relapsed. Functional analysis was unable to detect any factors associated with this other than loss of client-therapist contact, and the re-introduction of treatment with an emphasis on client self-reinforcement for progress produced significant improvement. This continued upon withdrawal of treatment and was maintained at a follow-up 6 months later. In addition, the intervention resulted in the client being able to exhibit increased control over the behavioural chain which culminated in hairs being extracted. A relationship appeared to exist between these two forms of behaviour change. The findings were discussed with regard to the proposed active change agents in the treatment of trichotillomania.

Treatment programmes involving a very brief period of Restitution and/or Positive Practice as derived from the overcorrection rationale, coupled with differential reinforcement of other behaviours, were successfully implemented with six severely mentally handicapped children who displayed either self-injurious or self-stimulatory behaviours. The reduction in the period of time devoted to Restitution and/or Positive Practice from the 20 min traditionally used to approximately 1 min is seen as beneficial in that it reduces demands on direct care-givers' time and stamina, while concurrently allowing an increase in the number of times the child associates the undesirable behaviour with its aversive consequences. The importance of positive reinforcement, the care necessary when using punishment procedures, however brief, in an institutional setting and the attitudes of direct care-givers are discussed.

This study assessed the effects of training the parents of children displaying problematic eating behaviors in child management skills. Specifically, parents were taught to apply a range of management procedures, e.g. differential reinforcement, behavior correction routines, extinction and time out, to their child's behavior during mealtimes. Subjects were four families, each of which contained a child displaying high rates of disruptive behavior, e.g. non-compliance, complaining, leaving the table during mealtimes, and low rates of food consumption. Each family underwent baseline, mealtime management training (M.M.T.), follow-up conditions within a multiple baseline across families' design. Home observations were conducted four nights each week, during the families' evening meal, and the dependent measures recorded were child behaviour, eating responses, and weight of food eaten. The results showed that M.M.T. was effective in decreasing disruptive behaviour for three of the four families. The fourth family also required home feedback training which resulted in a marked decrease in disruptive behavior. Changes in eating responses were less marked and highly variable among individual families. Follow-up results and the implications for clinical practice are discussed.