[Distance disturbance as a major problem in mental retardation. A case study]

Although "lack of distance" (indiscriminately friendly, attention-seeking behavior) is a wellknown problem behavior in children with psychiatric disorders and in those with mental retardation there is no exact definition of this behavior disorder and there are only vague indications as to its origins and how it is maintained. For a 14-year-old mentally retarded girl with frequent provocative-aggressive attention-seeking behavior we operationalized the disturbed behavior after observation of the phenomenology and frequency in different situations. Treatment began with training in cognitive discrimination of "known" adults and strangers, as part of pictures showing social interaction were used. This discrimination was then practiced with in-vivo therapy in everyday situations; in particular, unambiguous reactions to contacts with "known" adults and strangers were practiced. Correct responses (contact with "known" adults, turning away from strangers) were immediately reinforced socially and materially, and mistakes (i.e. making contract with strangers) were punished with time-out. In the course of these in-vivo sessions, behavior lacking distance ceased. Furthermore, the success of the therapy generalized well in everyday situations, which was assessed by another baseline assessment, and the effect on the girl's behavior in the home environment and at school was also stable.