I am a teacher of a 4-year-old boy with CdLS. I have worked with him for a year and half and have seen him make great strides in communication. We have a total communication approach with him. He uses sign language freely and also uses an augmentative communication device (digivox). It's hard to believe this is the same student who came to me. My questions and concerns for this child are his behavior. From the beginning, he has demonstrated extreme perseverative behavior. What we've seen happen over the last year and a half is that one behavior disappears, only to be replaced by another. At times, these behaviors (chewing on clothes, sweeping objects from work surfaces, taking off shoes, chewing on toys) interfere with learning. At other times he seems to be listening even though he is engrossed in an object. Should we ignore him when he is chewing on clothes? Should we insist that he keep his shoes on all day (he has taken them off continuously even when rewards were offered to keep them on)? Nothing seems to motivate him to stop these behaviors and I wonder if it is a part of CdLS that will not change. I don't want to give up trying to extinguish his behaviors, but if it is something that will not change, should I be looking at other areas to work on?
People with CdLS, like many people with mental retardation, are given to habits, mannerisms and stereotyped behaviors. They cannot be extinguished easily, however they are not a necessary, inevitable or immutable aspect of the syndrome. But they must be tolerated, at least to a degree.
There are two approaches to management: differential reinforcement of alternate or incompatible behavior; usually a question of engaging the child in an alternative behavior and gradually increasing the time he spends in an alternative behavior; and using the perseverative behavior as reward, a permitted recreation, and gradually reducing the time spent in it.
As children mature and their repertoire of behavior increases, they should spend less time perseverating. Use redirection rather than confrontation. Good luck.
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