&hats. RPS d Therapy, Vol. Ii’, pp.

515 to 518
Pergamon Press Ltd 1979. Prm~cd in Great Britain

CASE HISTORIES AND SHORTER COMMUNICATIONS

‘Ibe e&cts of overcorrection: a case study

(Received 15 January 1979)

!Summery--The effects of overcorrection on multiple problems were studied in a single case.

Whilst the techniques proved effective, they were extremely time-consuming and during treatment
periods there were large increases in collateral behavior. Clinical implications of these findings
are discussed.

The requirements for an acceptable intervention to change maladaptive behaviour in mentally handicapped
people are that the target behaviour is rapidly reduced and that the individual is helped to acquire new
skills. Overcorrection procedures seem to combine both these elements. Originally developed by Foxx and
Azrin (1972) the rationate for these procedures is that following a maladaptive behaviour, the individual
concerned should not only have to restore the situation which the behaviour disrupted (restitution), but
also have to practice appropriate behaviour in that same situation (positive practice overcor~tion~ The
procedure is a complex one and its theoretical status uncfear-it incorporates feedback, time-out (by preventing
access to other activities during the procedure), compliance training which punishes non-compliance and
negatively reinforces required appropriate behaviour, extinction and a contingent effort requirement. (Foxx
and Azrin, 1973; Epstein et al., 1974). But at a practical level case-reports suggest it can be rapidly and
enduringly effective with a wide range of maladaptive behaviour-aggression (Foxx and Azrin, 19723,self-injury
(Azrin et al., 1975), stereotyped behaviour (Foxx and Azrin, 1973). stripping (Foxx, 1976X and pica (Foxx
and Martin, 1975). Most of the published reports indicate positive results, although a few (e.g. Epstein et
al., 1974, Rollings, Baumeister and Baumeister, 1977) describe concomitant increases in other maladaptive
behaviour, some of which, as in the study by Rollings et al., were serious enough to require termination
of the study. A particular strength has been the fact that .staff find it more acceptable to implement such
techniques compared to time-out or physical punishment. (Foxx and Azrin, 1972).

METHOD

Peter was a severely mentally handicapped 1I-yr-old child, who had been resident in a long-stay institution
over the last 5 yr. Details of psychometric assessments are given in Table 1. Peter was ambulant and proficient
in all basic self help skills such as feeding, washing and dressing. He understood much of what was said
but had an expressive problem in that most of his utterances were repetitive consonant vowel combinations,
some of which were recognisable approximations to words, but others of which were jargon understood
only by those who knew him well. This problem was a source of considerable frustration and had been
the subject of intensive therapy, both traditional speech therapy and an operant programme, with little signifi-
cant improvement.
At the time of the study there were 3 main problems:-
i. Poking his own eyes: although of low ‘intensity, this behaviour was of high frequency averaging, during
initial baseline, 114.8 incidents per day. It made the child appear bizarre and if continued could lead
to tissue damage.
ii, Hand hiring: averaging 9.8 incidents per day during baseline required treatment for reasons similar
to eye-poking.
iii. ~bjecr-bre~ki~~ e.g., picking shoes to pieces, ripping up pictures and breaking play materials; the average
number of incidents per day during baseline was 48.0.
Setting
Peter was resident on a ward of 24 beds and attended day school on the hospital campus 5 days a
week. Although basic care standards on the ward were high, there were the problems that all such institutions
have in providing an adequate range of activities for the children, and a tendency for behaviour problems
to receive a disproportionate amount of staff attention. Overcoming these problems was the subject of a
separate study. By contrast Peter’s classroom had a high staffing ratio. Each child in the class was separately
assessed, and individual training goals plus a programme of developmentally appropriate free play were
drawn up. Behavioural techniques were used extensively to achieve curriculum goals.
Because the classroom offered a wide range of opportunities and reinforcement for appropriate behaviour.
it was decided to confine the study to this situation, at least initially. It was hoped in this way to develop
effective treatment procedures which co&d later be used in the ward environment when this had been improved
to the point that use of puni~ment techniques might be justified.

515
516

FXPFRIMFNTAL DFSIGN

I, Oh.srrcations
The frequency of each behaviour was recorded throughout the school day. The day was divided up and
one member of the classroom staff was assigned to observe (and later. treat) Peter during each period. All
classroom staff (5 in all). participated in the study. and all were familiar with data collection procedures
from work on other programmes in the classroom. During their observation periods. the staff assigned had
lo sit and watch Peter and note each time a behaviour occurred. Daily totals were derived and represented
graphically. Reliability data were not collected. This study was part of routine clinical management, and
the introduction of a second observer would have been such a highly discriminated situation that it is difficult
lo know what conclusions could have been drawn from either high or low reliability figures. All observers
were skilled in data collection; but whilst they understood the general aims of the treatment. they were
naive as to the details and rationale of the experimental design.

2. Trrotwnt conditions und desiyn

Procedures. For each target behaviour a correction procedure was developed:
i. Eye-poking: Whenever Peter poked his eye, the staff said -“Peter. No”. took him out of the class
to fetch a bottle of eye-bathing solution. and then went into the bathroom. He then had to bathe
his eye, dry it, wash out the eye-bath. wash and dry his own ha&. and return the solution to the
cupboard. On returning to the classroom. Peter was given brief functional movement training (Foxx
and Azrin. 1973) so that the whole procedure took IOmin.
ii. Hand-biting: Again he was told sharply-“Peter, No”. taken to the cupboard to collect an antiseptic
ointment. and then taken into the bathroom. He had to wash his hands. paying particular attention
to the part of the hand bitten. dry them and rub ointment on the part bitten. He then had to brush
his teeth, and return the ointment to the cupboard. Back in the schoolroom he was given brief functional
movement training so that again the whole procedure took IOmin.
111.Object-breaking: the procedure here was varied according to the objects damaged. Peter had to repair
the damaged toy using sellotape or glue, whichever was appropriate. and then tidy all the toys which
he had out on the table. As before, the procedure closed with brief functional movement training.

B’line Tt I Treatment 2 Treatment 3 SIX month

follow-up

P
P
Fi 50 -

G
0
m
F 100 -
1
E
e
h 50 -
t
s
t
0 0 r-P\- 45 I;,, ,;
5 I5
82 I 2 3 4 5
DtlYS

Fig. 1. Treatment I. Overcorrection with Eye Poking; Treatment 2. Overcorrection with Hand-
Biting; Treatment 3. Overcorrection with Object-Breaking.
 CASE HISTORIESAND SHORTER COMMUNICATIONS 517

The study was in operation throughout the school day (9.30-3.30) over a 6 month period (allowing for
week-ends and holidays), and a further week’s data was collected on a 6 month follow-up. A multiple baseline
design was used with the three behaviours as the elements in the design. Eye-poking was treated first, then
hand-biting and finally object breaking.

RESULTS
Figure 1 shows the daily incidence of the three targets during baseline, treatment and follow-up. It demon-
strates that the introduction of the appropriate correction procedure is followed by the rapid, complete
and enduring suppression of the target behaviour. These changes only occur in response to treatment. The
decline in destructive behaviour prior to its treatment took place because Peter was no longer allowed shoes,
only Wellington boots, and so the opportunities for destructive behaviour were reduced. Even so, in the
week before treatment for destructive behaviour, there was an average of six incidents per day.
Six months after the initial treatment period, follow-up data were collected for one week. The daily averages
for the three targets were 1.4 incidents for eye-poking, 0.2 for hand-biting, 0.0 for object breaking. The
effects of treatment were therefore sustained, and had generalized across settings as Peter had moved to
another class by the time follow-up data were collected. Overcorrection was a very effective method for
rapidly eliminating multiple behaviour problems in this case.
However, it was noted that during the treatment phase a wide-range of other types of behaviour seemed
to increase in frequency e.g. nose-touching, object flicking. Sometimes these occurred as much as 1,000 times
a day. Unfortunately no data were available on this behaviour prior to treatment and as none of it was
damaging to Peter or his environment, it was ignored and by the end of treatment and on follow-up, the
problems had declined and were hardly noticeable.

DISCUSSION

The results support the view that over-correction can be an effective means of controlling maladaptive
behaviour. In common with other behavioural techniques it is easily acquired by those who have no formal
training in psychology-in the present instance, treatment was carried out mainly by classroom assistants
under the direction of a teacher who had completed a course of training in the principles and techniques
of behaviour modification.
There are a number of draw-backs, however. The techniques are labour-intensive in that each event absorbs
the attention of one staff member for a considerable period of time (10min in the present study, at least
30 min in the study by Azrin et al., 1975). They are therefore applicable either in a well-staffed situation
or where the managers of the facility are prepared to assign an individual staff member(s) solely for the
treatment programme. Such environments are the exception, rather than the rule for mentally handicapped
people. It has been suggested (e.g., Rollings et al., 1977) that the treatment might be reduced to a brief
form, but there are no clinical studies yet to evaluate the efficacy of such a reduction.
A second problem is the increase in other undesirable behaviour as target responses decline. Recently
a number of studies have reported such effects during overcorrection treatments (e.g. Epstein, et al.. 1974:
Rollings et (II., 1977; Young and Clements. 1978) and during the present study there appeared to be changes
in frequency for other responses. Such concomitant changes in non-target responses have been reported
with other techniques, but not very often (e.g. Bucher and Lovaas, 1968; Pendergrass, 1971). There is a
need for research to study the conditions under which these changes occur, so that they might be avoided.
At present the clinician may be able to predict changes in target responses when treatment is introduced,
but other effects are unpredictable. This can have serious consequences for the credibility of any psychological
technique, particularly in the field of mental handicap where the psychologist is dependent upon other staff
to implement treatment programmes.

Psychology Department, J. CLEMENTS

Ely Hospital, M. DEWEY
Card@ CF3 5XE,
Wales

REFERENCES
AZRIN N. H., GOTTLIEB L., HUGHART L., WE~OLOWSKI M. D. and RAHN T. (1975) Eliminating self-injurious
behaviour by educative procedures. Behao. Res. Ther. 13, 101-l I I.
BUCHER B. and LOVAAS 0. I. (1968) Use of aversive stimulation in behaviour modification. In Miami Symposium
on the Prediction of Behavior, 1967: Aversive Stimulation (Ed. M. R. JONES), pp. 77-145. University of
Miami Press, Florida.
CORBETT J. (1975) Aversion for the treatment of self-injurious behaviour. J. ment. Dejic. Rrs. 19. 79995.
EPSTEIN L. H., DOKE L. A., SAJWAJ T. B., SORRELL S. and RIMMER B. (1974) Generality and side effects
of overcorrection. J. appl. Behal;. Anal. 7, 385-390.
FOXX R. M. and AZRIN N. H. (1972) Restitution: a method of eliminating aggressive-disruptive behaviour
of retarded and brain damaged patients. Behau. Res. Ther. 10, 15-27.
Foxx R. M. and AZRIN N. H. (1973) The elimination of autistic self-stimulatory behaviour by overcorrection.
.I. appl. Behav. Anal. 6. 1-14.
Foxx R. M. (1976) The use of overcorrection to eliminate the public disrobing (stripping) of retarded women.
Behav. Res. Ther. 14, 53-61.
Foxx R. M. and MARTIN E. D. (1975) Treatment of scavenging behaviour (coprophagy and pica) by overcorrec-
tion. Behav. Res. Thei. 13, 1533162.
GARDNER W. I. (1969) Use of punishment procedures with the severely retarded: a review. Am. J. ment.
Deft. 74, 80-103.
B.R.T.17/5-H
518 (‘ASKHlSTORltSAND SHORTER COMMUNlCATlONS

PINIXRGRASS V. E. (1971)Etlects of length of time-out from positive reinforcement and schedule of application
in suppression of aggressive behavior. Psycho/. Rec. 21. 75-80.
ROLLINCS J. P.. BAUMEISTI:RA. A. and BAUMEISTER A:A. The use of overcorrection procedures to eliminate
the stereotyped behaviours of retarded individuals. B&K. Modifcarion. I, 29-46.
SMOLEV S. R. (1971) Use of operant techniques for the modification of self-injurious behaviours. AFH. J.
~wut. Lkfic. 76. 295m 305.
YOUNG R. and CLEMFNTS J. C. (I 978) The functional significance of complex hand stereotypes in the severely
retarded. Unpublished paper.