CONDITIONING PROCESSES IN BREATH-HOLDING SPELLS

Breath holding spells often arise in the context of affectively dramat ic conflict situations between mother and child. Assessment by psychop athological screening instruments, however, has not given empirical ev idence of an increased psychiatric morbidity in these children. Theref ore, in our study we did not concentrate on basic psychopathology but on behavioral variables that might be effective during the ongoing att ack episode and, hereby, exert an influence on the risk of chronificat ion (relapse rate). The main goal of this approach is to examine secon dary reinforcement effects on the attack behavior according to the lea rning principle of operant conditioning. Our sample consisted of 28 ch ildren and ten siblings as control group. To control for effects of be havioral disorders in the sample, we applied the Marburger Verhal-tens liste (MVL) on the level of the child, and the Familienfragebogen (FFB O-III) on the level of family adaptation. The main assessment intrumen t, however, was the Functional Behavior Analysis (FBA) in order to mea sure the trigger, reaction and consequence conditions in the course of given attack episodes. MVL and FFBO-III results confirm the lack of b asic psychopathology in the patients and their families. The individua lized FBA's can be transformed in a taxonomy of five distinct types. A ll the first three types are triggered by intensive conflict situation s and show a high relapse rate (type 1) if the mother reacts in a rewa rding manner with positive consequences for the child (reinforcement c ondition), a dramatically reduced rate (type 2) if the mother reacts n eutral (extinction condition), or a heterogenous pattern (type 3) if t he mother reacts punishing (punishment condition). In type 4 (pallid t ype) and type 5 (triggered spontaneously), respectively, no responsive ness to conditioning effects can be recognized. With respect to parent counselling, a recommendation for a quiet and consequent reaction can be concluded, especially in the case of a preceding conflict situatio n. The empirical results are integrated into a hypothetical model on p athogenesis that delineates the interaction of neurophysiological and behavioral factors in the maintenance of breath-holding spells.