J. ment. Defic. Res.

(1982) 26, 163-175

RELATIONSHIPS BETWEEN SENSORY

STIMULATION AND
STEREOTYPED BEHAVIOUR IN SEVERELY
MENTALLY
RETARDED AND AUTISTIC CHILDREN
ELIZABETH GOODALL

Department of Child Psychiatry,

Institute of Psychiatry, Denmark Hill, London
AND
J . CORBETT

Hilda Lewis House, Bethlem Royal and the Maudsley Hospital, Croydon

INTRODUCTION
Previous research suggests that environmental stimulation can have different effects on
stereotyped, repetitive behaviour in mentally retarded people, depending on the nature
of the stereotypies and the stimuli provided (Baumeister & Forehand, 1973; Baumeister, 1978).
This has led to different hypotheses about the nature of stereotyped behaviour. The
first is that stereotypies are self-stimulatory, maintaining an optimal level of'arousal' in
individuals who are under-stimulated, and who lack the skills to engage in alternative
activities due to impaired perception or environmental deprivation. It follows from this
that the provision of alternative stimulation may reduce the occurrence of stereotyped
behaviour (Forehand & Baumeister, 1970; Berkson & Mason, 1964).
The second main group of 'arousal' theories propose that stereotyped movements
result from increase in arousal produced by drives such as hunger, or intense stimulation from sound or fluorescent light (Kaufman & Levitt, 1965; Levitt & Kaufman,
1965; Forehand & Baumeister, 1970; Higenbottam & Chow, 1975; Hollis, 1978;
Colman, Frankel, Ritvo & Freeman, 1976). Hutt & Hutt (1965) also suggest that
stereotyped movements may block further sensory input under conditions of chronic
high arousal in autistic children.
Williams & Surtees (1975), have expressed the relationship between stereotyped
behaviour and arousal in the form of a U-shaped curve. They have replaced the concept
'arousal' with the more observable 'environmental stimulus level' so that conditions of
Requests for offprints should be addressed to Mrs E. Goodall, Hilda Lewis House, The
Bethlem Royal Hospital, 579 Wickham Road, Shirley, Croydon CRO 8DR.
Received 19 April 1982
0022-264X/82/0900-0163$02.00 1982 Blackwell Scientific Publications
163

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E L I Z A B E T H G O O D A L L and J. C O R B E T T

both over-stimulation and under-stimulation are directly related to increases in

stereotypy. When there is optimal stimulus input, stereotyped behaviour is minimized
and learning is maximized.
There is some experimental evidence to suggest that stereotyped behaviour in the
same individual may be affected differently by different environmental stimuli.
Presentation of white light and coloured pictures has been associated with decreased
body rocking in subjects who had shown increase in this behaviour with sound
stimulation (Forehand & Baumeister, 1970).
Recent research has led to renewed interest in the systematic use of sensory
stimulation as a reinforcer for various operant behaviour, such as lever pulling or switch
touching, or in the development of more complex skills (Frankel etal., 1976; Freeman,
Frankel & Ritvo, 1976; Byrne & Stevens, 1980; M u r p h y , 1982a, 1982b; Rincoveref a/.,
1977). T h e possible reinforcing nature of stereotyped behaviour has been demonstrated
by Rincover (1978), who described a reduction in stereotyped movements by eliminating the sensory feedback that the subject was thought to receive. There have, however,
been few systematic studies of the temporal relationships between sensory stimulation,
which has been under the subject's control, and the frequency of stereotyped behaviour
(Williams, 1975, 1978). Other studies have not monitored the effect of stereotyped
behaviour during sensory stimulation experiments, (Frankel et al., 1976; Freeman et
al., 1976).
T h e peripheral self-stimulation techniques, developed by Campbell (1972), have
been used in the present study to analyse the relative reinforcing properties of sensory
stimuli (continuous and flashing white light, sound and vibration), in mentally retarded
subjects showing stereotyped behaviour. T h e effect of this alternative stimulation on
the amount of stereotyped behaviour has been examined. Previous experimental evidence suggests that the mechanisms underlying stereotyped behaviour and the effects
of sensory stimulation may be different in children showing symptoms of childhood
autism from other children with mental retardation, (Frankel et al., 1976; Freeman et
al., 1976; H u t t & H u t t , 1965). In order to explore whether there were any clinical
correlations with patterns of response to sensory stimuli, three groups of children
matched for mental age were included: a group with Down's syndrome, a group with
Rubella Embryopathy who had severe sensory defects, and a group with neither of
these diagnoses. Autistic characteristics were examined across the three groups, and
individual patterns of response to peripheral self-stimulation have been examined in
relation to these and other clinical findings.

METHOD
Subjects *
T h e subjects were 24 severely mentally retarded children who showed stereotyped
behaviour. There were 11 girls, and 13 boys. Eight subjects were diagnosed as having
Down's syndrome, (mean CA, 15 years 5 months), eight subjects had Rubella
*The authors will provide full details of the clinical characteristics on request.

STIMULI AND STEREOTYPED BEHAVIOUR

165

embryopathy, (mean CA, 14 years 1 month), while eight subjects suffered from mental
retardation of unknown aetiology, (mean CA, 14 years 4 months).
Clinical history
Psychological assessments were carried out using the Bayley Scale of Infant Development or Merrill Palmer Scales and Reynell Developmental Language Scales where
appropriate. (Down's syndrome, MA range 5-40 months; Rubella subjects, MA range
5-19 months; unknown aetiology, MA range 92-38 months).
The children were examined for sensory defects and details of their case histories
were taken from hospital records. Particular notes of any history of epilepsy and details
of medication were made.
Of the Rubella group, one subject was totally blind and partially deaf, six subjects
were either partially hearing or sighted or both; one subject had only a partial hearing
defect.
None of the Down's or unknown aetiology group had severe sensory defects.
The Schedule of Children's Handicaps, Behaviours and Skills (Wing & Gould,
1978) was completed with the ward sister after testing was finished. The Vineland
Social Maturity Score and social age was derived from this schedule. (Down's syndrome, SA range 10-40 months; Rubella subjects, SA range 10-44 months; unknown
aetiology, SA range 13-38 months).
Apparatus
Testing took place in an experimental room 2.1 x 3.6 m, containing three chairs, the
experimental table, and recording equipment. The room was illuminated by natural
light, and had an ambient sound level of 40 dB. The apparatus was in two parts; an
experimental table containing a flat removable panel, which could be replaced by a
console measuring 15 x 32 cm, which had two lamps and a loud speaker fitted into the
sloping front surface. At the front of the console was a metal cylinder acting as a
capacitance switch. Four pre-determined sensory stimuli could be elicited by the
subject touching the switch. The console was connected to control and recording
equipment by a low voltage cable 5 metres in length.
Stimuli
(a) Continuous white light from a 12 V, 24 W frosted filament lamp of variable intensity.
(b) Flashing white light from a xenon-filled photographic flash gun, MFT 110, which
had a flash voltage of 350 V DC and duration per fiash of 200 ;u,s. The rate of fiash was
set at 6 flashes/s.
(c) High frequency synthesised sounds from a tape recording of varying intensity,
(approximately 70 dB).
(d) Vibration provided by a small electric motor housed in the casing ofthe capacitance
switch, and which had an eccentric fiy wheel attached to its spindle. (When the motor
rotated the cylinder vibrated on rubber sprung mountings. The amount of vibration
was governed by a variable potentiometer control). The sound level was 63 dB and
vibration 30 Hz.

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E L I Z A B E T H G O O D A L L a n d J . CORBETT

Sensory stimulation was contingent on the cylinder being touched up to a maximum

of 5 s. If the switch was touched for longer than this the stimulus would cease, and the
switch would need to be re-touched to receive further stimulation. The number of times
the switch was touched and the total duration of stimulation in seconds was recorded
automatically.
Design
The experiment was conducted in three stages.
(a) Baselinestereotyped behaviour was observed while the child was unoccupied,
seated at the table without the console in place.
(b) Sensory stimulationStereotyped behaviour and duration of stimulation were
recorded when each of the four sensory stimuli was available.
(c) ExtinctionStereotyped behaviour and number and duration of switch touches was
recorded when stimuli were no longer available.
Procedure
The children were tested every morning (for 3-4 weeks). The subject was sat at the table
by the experimenter, who then remained in the room to make behavioural observations.
If the child got up, he was replaced on the chair once only. The observer maintained as
little contact as possible with the child.
Five 5-minute baseline trials took place over three days, not more than two trials
being given on any day.
Eight 5-minute trials took place witheach sensory stimulus, the console being in place
in the table top for these trials. Generally three trials were given each day, and allowed
for:
(a) light stimuli to be alternated with other sensory modes.
(b) each day's testing to start with equal number of trials with each stimulus, but these
to be ordered as randomly as possible.
(c) all four stimuli to be presented as evenly as possible throughout the testing period,
so that no stimulus was finished several days before the others.
Finally, five 5-minute extinction trials took place over three days, when the console
was present, but no stimulus was elicited when the subject touched the switch.
Prompting
At the start of the first sensory stimulation trial (which was always white light, in order
to make the conditions the same for each child) the child was seated at the table, and no
instruction was given. Many children spontaneously touched the switch, noticed the
stimulus and continued to touch, without prompting.
If the child failed to touch the switch spontaneously minimal systematic prompting
was^iven before the start of the trials. If a child failed to reach a response criterion, he
was not tested further.
Direct observation of stereotyped behaviour
A study of the accuracy of samphng methods used in direct observation showed that

STIMULI AND STEREOTYPED BEHAVIOUR

167

momentary (Is) time sampling of behaviour every 10 s gave a percentage duration close
to the percent duration recorded on video tape, and gave consistently less error than
interval recording, which over-estimated percentage duration (Murphy & Goodall,
1980),
Using this method each 5-minute trial gave 30 observation intervals. The timing of
observation was controlled by audio-cueing. If a behaviour occurred at all during a one
second observation period, it was scored as being present.
Definition of behavioural categories

A check list of behaviours was compiled, based on those of Berkson & Mason (1963,
1964) and Davis, Sprague & Werry (1969). Behaviours were divided into five
categories: body/head movements, hand movements, oral stereotypies, eye-poking,
and self-manipulation (see Table 1).

Table 1. Individual stereotypies included in each category of behaviour

Category
Body movements

Hand movements

Oral stereotypies

Self-manipulation

Eye-poking

Individual stereotypy
Body rocking, swaying, weaving; head nodding, shaking,
weaving; leaning back, bizarre body or head postures;
standing and turning movements.
Hand flapping, hand/finger postures and movements, finger
drumming; hand to mouth, ear, face; pulling and smearing
saliva; tapping mouth.
Repetitive speech, sounds, snorting, blowing, puffing,
clicking, moaning; mouth, lip, jaw, neck movements; teeth
grinding.
Fingers in mouth, ear; hand over ear, mouth; hand pressed
against throat; self-pinching biting, slapping, rubbing body;
masturbating.
Finger in eye, hand pressing against eye or eyebrow.

It was possible for a child to show more than one distinct behaviour in one category,
e.g. hand flap, and hand to face. The number of behaviours observed ranged from two
to six per subject.
Individual behaviours were amalgamated within categories. An 'intervals of occurrence score' was obtained for each category of behaviour for each trial (max. score = 30)
which was converted into a 'percentage duration' score.
Two further measures were calculated: 'total stereotypy score' for each trial, which
was the sum of the number of intervals that all categories of behaviour occurred for each
trial. This took account of the total amount of stereotyped behaviour occurring, as
many children carried out several categories at the same time. 'Absence of stereotypy'
was the number of intervals in which no stereotypy at all occurred, and was expressed as
a percentage.

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E L I Z A B E T H G O O D A L L and J. C O R B E T T

Reliability
Inter-observer reliability checks were made, (using audio-cueing) on average, once
every six trials. (The second observer was experienced in direct observation). Reliability
( R T O T ) was calculated (for each behavioural category) of the number of intervals in
which there was agreement and expressed as a percentage of the total n u m b e r of
intervals (see Table 2).
Many stereotypies occurred infrequently. Occurrence and non-occurrence
reliabilities (Rocc and RNON-OCC) (Hartman, 1977) were also calculated.
% Rocc =

no. of intervals both observers agree on occurrence

30 - no. of intervals both observers agree on non-occurrence

xlOO.

This stringent procedure accounts for the relatively low occurrence reliability
scores.
Table 2. Reliabilities for direct observation of behaviour
Mean percentage
reliability for
occurrence of stereotyped
behaviour (Rocc)

Mean percentage
reliability for total
agreement (RTOT)

Mean percentage
reliability for nonoccurrence of stereotyped
behaviour (RNON-OCC)

Down's (n= 8)

91
(84-95)

64
(47-86)

Rubella (n =8)

92
(88-94)

76
(64-94)

83
(72-93)
89
(80-95)

Unknown (n=8)

92
(83-98)

69
(54-85)

88
(81-94)

*The ranges are given in parentheses below mean percentage.

RESULTS
Group analysis
Baseline stereotypy. The mean baseline total stereotypy levels (over five trials) for the
three diagnostic groups of children were compared, using one-way analysis of variance.
The amount of stereotyped behaviour shown by the children in the Rubella group was
higher than that shown by the Down's syndrome and 'unknown' groups. The difference was significant at the 5% level (F = 7.6, d.f. 1 & 21).
Five children failed to reach the response criterion (two rubella and three
unknown). No differences were found in their baseline stereotypy levels compared with
children who passed the criterion.
Sensory stimulation. Repeat measures, using a three-way analysis of variance, compared duration of stimulation, total stereotypy, and absence of stereotypy for diagnostic

STIMULI AND STEREOTYPED BEHAVIOUR

169

groups, sensory stimulation conditions and trials ( = 1 8 . The five children who failed
the criterion and a Down's syndrome child who had incomplete results, were
excluded). It was found that the duration of stimulation for white light was lower than
the remaining conditions (vibration, flashing light and sound). This difference was
significant at the 1% level ( F = 9.2123, d.f. 1 & 15, P<0.0084). There were no
interactions between trials and conditions, trials and groups, or conditions and groups.
No significant differences were found for either measure of stereotypy level.
Comparison of sensory stimulation conditions with extinction
The duration of switch touching was reduced during extinction when no stimulus was
available. Each stimulus condition was tested against extinction by means of an F test and
in each case the difference was significant (see Table 3). No differences were found
between diagnostic groups.
Table 3. Significance levels for comparison of means between percentage duration sensory
stimulation and percentage during extinction conditions

Continuous white light

Flashing white light
Vibration
Sound

Percentage duration
stimulation (n=18;
all groups combined)

Extinction percentage
duration

20.7*
24.2t
29.3t
29.9t

12.4
12.4
12.4
12.4

*P<0.05; tP<0.01; tP<0.001.

The mean total stereotypy score was significantly reduced when each sensory
stimulus was available, compared with extinction (see Table 4). The percentage duration for absence of stereotypy was significantly higher when sensory stimulation was
available.
Table 4. Significance levels for comparison of means of total stereotypy scores between sensory stimulation and extinction condition

Continuous light
Flashing light
Vibrator
Sound

Total stereotypy
score (n=18)

Extinction

26.5*
25.9t
25.lt
26.3*

30.9
30.9
30.9
30.9

*P<0.05; tP<0.01. Mean baseline stereotypy score=33.0.

No statistical comparisons were made between baseline stereotypy score and
stereotypy during sensory stimulation trials because the experimental conditions were
not identical (the console was not in place in baselitie trials, as the child would not have

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E L I Z A B E T H G O O D A L L a n d J . CORBETT

been unoccupied and the presence of the switch then might have led to considerable
prompting being needed during sensory stimulation trials). However, the mean
baseline stereotypy score was 33.0 (n = 18, cf. extinction score of 30.9, Table 4)
showing a classical reversal effect when sensory stimulation was available.
Correlation between stereotypy scores and duration of stimulation

The Pearson correlation co-efficients between duration of stimulation, (mean stimulation over trials), and mean stereotypy scores were calculated, taking the 18 subjects
together, and also taking the subjects in each diagnostic group.
There was a significant negative correlation between amount of light and vibration
sought and total amount of stereotyped behaviour shown by the 18 subjects (Table 5).
Similarly, sensory stimulation was positively correlated with absence of stereotypy
which was significant for all four stimulus conditions.
Table 5. Pearson correlation coefficient (r) between sensory stimulation and total stereotypy

All subjects ( = 18)

Down's (n=7)
Rubella (n= 6)
'Other'(n = 5)

Continuous
light (r)
-0.7126t
-0.6784
-0.8298*
-0.9872t

Flashing
light (r)
-0.7263t
-0.8126*
-0.8615*
-0.4445 n.s.

Vibration
(r)
-0.6127t
-0.7433*
-0.6269 n.s.
-0.9294*

Sound
(r)

-0.4789
-0.6332
-0.4868
-0.2827

n.s.
n.s.
n.s.
n.s.

*P<0.05; tP<0.01;

ANALYSIS
STIMULI

OF

INDIVIDUAL

RESPONSES

TO

SENSORY

Each child's responses were analysed to show individual sensory preferences and to
examine in detail the effect of the stimuli on stereotyped behaviour.
Percentage durations for the eight trials with each stimulus condition were compared with the five extinction trials for each child using f-tests. A cut-off point for the
t-values of 2 was empirically chosen to indicate criteria for:
(a) preferred stimuli (which reinforced switch touching) or
(b) reduction in the stereotyped behaviour (negative value) or
(c) increase in stereotyped behaviour (positive value).
Of the 24 children, five failed the original response criterion (see above), six showed
no sensory preferences or change in stereotypies, 13 were reinforced in switch touching
by at least one stimulus and of these three showed no change in behaviour. In six
children one or more stereotyped behaviours was reduced for at least one stimulus.
In four children, however, one stereotyped behaviour was increased. This occurred
during the sound stimulation condition and also with constant light for two. In three of
the four children this increase in one stereotypy was accompanied by decrease in another
stereotyped behaviour (e.g. hand movements increased while eye poking was
decreased). The results are summarized in Figure 1.

STIMULI AND STEREOTYPED BEHAVIOUR

171

Unknown
aetiology

number ot childron
with
sensory proterences

Figure 1. Summary of individual

children's
patterns
^_^ of
response. 1 ^ failed criterion; L J no
sensory preferences (but passed criterion); I I no
changes
in
behaviour; I J decrease seen in at
least one behaviour for at least one
stimulus; fSf^ increase seen in at least
one behaviour for sound (+light),
decreases seen in other behaviours or
conditions.

I1

number of children
witti no sensory
preferences or who
failed criterion

No increases in stereotypy were found with vibration or flashing light. The differences in the children's response to vibration and sound neared significance. (P<0.05
Fisher's exact probability one-tailed test).
Correlation between individual patterns of response and diagnoses, sensory defects and other
clinical features

The children were divided into two response groups; those with sensory preferences
(n = 13) (above line in Figure 1), and those without preferences or who failed the
response criterion (n =11) (below" line in Figure 1). The difference in the number of
Down's children and those with unknown aetiology who found sensory stimuli reinforcing was significant (P<0.05 Fisher's exact probability two-tailed test). No correlations were found between diagnosis and effect on stereotyped behaviour. There were no
differences in sensory defects between the Down's and the 'unknown' group, nor
between those Rubella children who responded to sensory stimuli and those who did
not.
Cognitive ability
The children were divided, on the basis of their scores in psychological assessment, into
a higher and a lower mental age group (Murphy, 1982b). No correlation was found
between mental age level and response to sensory stimuli.
Behaviour abnormalities
Information from sections covering the 'triad of social and language impairments', of the
Handicap, Behaviour and Skills, (HBS) Schedule, (Wing & Gould, 1978; 1979;
Wing, 1981) was analysed for each child.
Twenty-one of the children were rated as socially impaired, twenty being in the
'aloof sub-group. Nineteen children had an overall pattern of interest that was invari-

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E L I Z A B E T H G O O D A L L and J. C O R B E T T

ably repetitive. None of the children showed imaginative play or elaborate repetitive
routines. All the children had severe language delays, nine were m u t e , ten babbled
without meaning. Only two used two word phrases, but both had delayed echolalia.
No significant associations were found between any of these behavioural abnormalities and the children's patterns of response to sensory stimuli, seven children had
some understanding and use of gesture but this was not correlated with their response to
sensory stimulation.
Behaviour problems shown by children with limited, or no social awareness, were
also analysed. Significant correlations with response to sensory stimuli were found for
the following items, temper tantrums, aggression and crying or moaning. Presence of
these behaviours were associated with lack of interest in sensory stimulation.

DISCUSSION
For the subjects as a whole, the amount of time the switch was touched when stimuli
were available, was significantly higher than during extinction trials: all the stimuli
were therefore acting to reinforce switch touching behaviour. The percentage duration
for the continuous light was significantly less than the other stimuli, suggesting that this
stimulus is less reinforcing than flashing light, vibration or sound. There was, however,
no difference in the amount of stereotyped behaviour shown when continuous light
trials were compared with other stimuli.
Stereotyped behaviour increased significantly during extinction, and there was a
negative correlation between duration of sensory stimulation and stereotypy. These
group results support the theory that the function of stereotyped behaviour is to
increase self-stimulation, the behaviour being maintained by the reinforcing properties
of the sensations it produced (Williams, 1978). If an environmental sensory stimulus
proved to be more reinforcing than the stereotyped behaviour, the alternative activity
(switch touching), upon which this stimulus was contingent, was increased, and the
stereotyped behaviour decreased.
The analysis of variance showed no differences in amount of response to sensory
stimulation between diagnostic groups (due to the large amount of between subject
variance).
The Rubella group was found to have a higher baseline stereotypy score which is
similar to previous reports on blindisms in sensorily impaired people (Stone, 1964), but
differences in baseline stereotypy did not account for those who passed the criterion and
those whose interest in environmental stimulation was so limited that they failed to
meet the criterion.
Although the group analyses support the self-stimulation theory, these masked
individual differences in stereotypy levels. Some children showed an increase in one
behaviour, in response to a particular stimulus, (sound), while other stereotyped
behaviours decreased. This reaction by four children to sound stimulation is in line with
reports in the literature, and supports the arousal hypothesis.
There were also interesting differences in quality of response between individuals
which can be seen in Figure 1, such that the difference in the number of children
finding sensory stimuli reinforcing in the Down's and unknown aetiology groups was
significant. These findings raise questions as to whether the behaviours are functionally

STIMULI AND STEREOTYPED BEHAVIOUR

173

differentiated within individual children, or whether the results may be accounted for
by differences in the nature of the stimuli. The dichotomy of response of different
behaviours within an individual to the same stimulus, has also been noted by
Romanczyk & Kistner (1980). Young & Clements (1979), have reported different
psychophysiological responses occurring in three retardates when engaged in rocking
and complex hand movements. The fact that increase in stereotypy with sound stimulation only occurred for some subjects, suggests that mechanisms underlying the
response may be related to clinical differences in the children. In particular, it was
thought possible that the abnormal response to sensory stimuli in the natural environment, shown by children with 'autistic' behaviour, might be reflected in the relationship of response of stereotyped behaviour to peripheral stimuli.
The analysis of the HBS schedule did not reveal any significant differences relating
to social and language impairments between those who responded to sensory stimuli
and those who did not. There was perhaps an indication that some of those who showed
an increase in stereotypy in response to sound were among the less retarded and were
the least socially impaired. The severity of the mental retardation and the small number
of children may be reasons why no correlations between autistic features and response
to sensory stimuli have been found. Other behavioural problems (temper tantrums,
aggression, crying or moaning) were, however, correlated with lack of interest in
sensory stimulation.
All the children lacked imaginative play supporting the results of the Camberwell
Survey which reported a relationship between lack of symbolic play and repetitive
behaviour (Wing & Gould 1979).
The results discussed refiect the problems of experimental design inherent in
mental retardation research. Single-case analyses show interesting variations among
individuals which may be important in understanding the function of stereotypy but
inferences about populations can only be made from large numbers. It appears that
stereotypy does not function as a unitary response even within an individual.
Use of sensory stimulation in treatment of mentally handicapped people
Sensory stimuli have been found reinforcing in that they increase the likelihood of a
simple switch being touched, and at the same time reduce stereotypy. It is hoped that
these stimuli will prove reinforcing in teaching more complex tasks, particularly with
children where conventional reinforcers, such as food or social praise, are ineffective.
Equipment has been designed to this end (Goodall et al., 1981; 1982).
SUMMARY
The reinforcing properties of four sensory stimuli (continuous and fiashing light,
vibration and sound) which were under the subject's control, were examined and the
effect on stereotyped behaviour observed. The subjects were 24 severely retarded
children in three diagnostic groups; Down's, Rubella and a group which included
neither of these diagnoses. Duration of stimulation with continuous light was significantly lower than the other three stimuli, but there were no differential effects on
stereotypy, nor diagnostic group differences.

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E L I Z A B E T H G O O D A L L a n d J . CORBETT

Switch touching was significantly reduced and stereotypy significantly increased

during extinction.
These group analyses are interpreted to support the self-stimulation theory of
stereotypy, b u t the individual differences in response suggest that all stereotyped
behaviours cannot be regarded as a unitary response class. Individual responses are
discussed in relation to clinical correlations and other theories on stereotypy.
ACKNOWLEDGEMENTS
The authors would like to thank Dr H. J. Campbell whose original research at Hilda
Lewis House led to this project and for his advice which made this study possible.
Much of this research took place at Queen Mary's Hospital, Carshalton. The
authors are most grateful to Dr V. Cowie, Dr M. Faulkner, Dr S. Shivanathan, Mrs N.
Scott, Mrs B. Thomas, and all the staff for their help and co-operation.
They would particularly like to thank Glynis Murphy, Institute of Psychiatry, for
carrying out the psychological assessments and observing during reliability trials and
for many helpful discussions; Dr Lorna Wing, MRC Social Psychiatry Unit for her
advice and the use of the HBS Schedule, and John Clements for his helpful comments
on the paper.
The authors are grateful to Mr Brian Everitt, Biometrics Unit, Institute of
Psychiatry, for carrying out the group statistical analyses and to Mr F. Goldsmith for
designing the equipment.
This research was supported by a grant from the Mental Health Foundation.
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