Aversive control of self-injurious behavior in a psychotic boy

Two studies are reported which indicate how quickly and effectively chronic self-injurious behavior was controlled in a 9-yr-old blind psychotic boy. In the first study, the self-injurious responses were punished by contingent withdrawal of human physical contact. In the second study, response-contingent electric shock was employed.     

The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior.

Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988.     

On the relation between object manipulation and stereotypic self-injurious behavior

Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required.     

A comparison of procedures for eliminating self-injurious behavior of retarded adolescents

An attempt was made to eliminate the self-injurious behaviors of four institutionalized, profoundly retarded adolescents. Some of the behaviors studied were: face-slapping, face-banging, hair-pulling, face-scratching, and finger-biting. Three remediative approaches to self-injurious behavior were compared. Elimination of all social consequences of the self-injurious behavior was not effective with the two subjects with whom it was attempted. The same two subjects were exposed to a procedure involving reinforcement of non-self-injurious behavior which was ineffective under no food deprivation and was effective with one of the two subjects under mild food deprivation. Electric-shock punishment eliminated the self-injurious behaviors of all four subjects with whom it was attempted. The results suggested that punishment was more effective than differential reinforcement of non-self-injurious behavior which, in turn, was more effective than extinction through elimination of social consequences. However, the effects of the punishment were usually specific to the setting in which it was administered. In order to eliminate the self-injurious behaviors of severely retarded children, it is apparently necessary to carry out the treatment in many of the settings in which it occurs.     

False-positive maintenance of self-injurious behavior by access to tangible reinforcers.

Results of a functional analysis indicated that the hand mouthing of a woman with developmental disabilities was maintained by multiple sources of control (sensory stimulation and access to a leisure item). Further assessment revealed that access to several other items also produced high rates of hand mouthing. However, direct observation conducted in the woman's home indicated that none of these items was delivered contingent upon hand mouthing. When the consequence observed most frequently in the home was incorporated into the functional analysis, rates of hand mouthing were no higher than they were during an alone condition. We concluded that hand mouthing, although maintained by automatic reinforcement, was also susceptible to social contingencies when exposed to them during assessment, thereby producing a partially false-positive outcome.     

The use of brief restraint plus reinforcement to treat self-injurious behavior

This study evaluated the use of brief arm restraint plus differential reinforcement of alternative behavior to treat the self-injurious behavior of two residents with multiple handicaps and profound mental retardation. The study took place in a nursing home and sessions were conducted for 15 minutes, Monday through Friday. The design contained both multiple baseline and reversal components. Mean levels of self-injurious behavior and stripping for one client were reduced from 92 to 16% and 81 to 2%, respectively, by the treatment. Her appropriate behavior increased from a mean of 18% in baseline to 100% in treatment. The second client's self-injurious behavior averaged 39% in baseline, but was reduced to a mean of 9% in treatment. His throwing decreased from a mean of 54% prior to treatment to a mean of 2%, while appropriate object manipulation increased from 26 to 99%. These data support the use of brief restraint plus reinforcement for decelerating severe self-injurious behaviors and accelerating appropriate behaviors in adults with profound mental retardation. The advantages of this treatment are that it appears to be less intrusive and to offer more educational benefits than other commonly used techniques.     

Punishment of self-injurious behavior in natural settings using contingent aromatic ammonia

Contingent aromatic ammonia suppressed the self-injurious behavior (SIB) of two retarded children in clinic, home and school settings. In Study 1. several reversals demonstrated the effectiveness of a 3-s ammonia contingency in the deceleration of hair-pulling in the clinic after a momentary ammonia contingency was shown to be no different from differential reinforcement of other behavior (DRO). Family members and school personnel suppressed the behavior in the home, grandparents' home and school in multiple baseline fashion. Difficulties in long term maintenance were encountered and discussed. In Study 2, a multiple baseline across Trainers 1 and 2 in a preschool setting and mother at home demonstrated the effectiveness of response-duration ammonia in eliminating hand-biting. Complete suppression was maintained at a 1-year follow-up. These studies replicated the suppressive effects of aromatic ammonia, extended the findings to children with different SIBs in natural settings with family members and teachers as therapists, demonstrated the necessity for different durations of ammonia, and suggested that maintenance must be assessed and programmed rather than assumed.     

Helmet restraint and visual screening as treatment for self-injurious behavior in persons who have profound mental retardation

Enhancement of sensory, cutaneous stimulation may be one reason for self-injurious behavior among persons with mental retardation. For self-injury involving head or face, a contingently applied helmet prevents access to the sensitized skin area. Such a restraint procedure, with visual occlusion superimposed on the helmet, was tested with two women who are profoundly retarded. Helmet and transparent shield reduced target responses by both women to approximately 7% of baseline rates. When the helmet's face shield was made opaque, a small, further response reduction was obtained. Stable, low rates were maintained over a 6-month maintenance period.     

Comparison of non-suicidal self-injurious behavior and suicide attempts in patients admitted to a psychiatric crisis unit

The aim of the current study was to examine differences in personality, coping skills, and select psychopathology symptoms in psychiatric patients with and without non-suicidal self-injury and/or suicide attempts. We collected data in a sample of 128 psychiatric patients by means of self-report questionnaires measuring self-harm, psychological symptoms, personality and coping skills. Results support a continuum of self-harm such that patients with both non-suicidal self-injury and suicide attempts exhibit significantly greater levels of psychopathology and lower levels of adaptive personality traits and coping skills. The findings point to the clinical importance of making a distinction between non-suicidal self-injury and suicide attempts, and offers additional variables to consider outside of intent when appraising suicide risk.     

Developing a screening instrument and at-risk profile for nonsuicidal self-injurious behavior in college women and men

Archival data (N = 1,048 women, 1,136 men) from a mental health survey of college students were used to investigate incidence of nonsuicidal self-injury (NSSI), including cutting. Significant levels (defined as 4-5 lifetime incidents) were found in 9.3% of women and 5.3% of men. The Counseling Center Assessment for Psychological Symptoms (a global symptom inventory) and an assessment of trauma had been field tested with this sample. We randomly partitioned half of these data into a holdout sample and used the remainder to develop an NSSI screening inventory that included (a) 5 women's screening items, including 1 item to assess trauma experienced; (b) 11 men's screening items; and (c) 12 items common to men and women, including depression, dissociation, anger, unwanted thoughts, nightmares or flashbacks, and having witnessed trauma. Logistic regression and receiver-operating characteristic curve analysis suggested the inventory significantly discriminated NSSI men and women in the holdout sample, p < .001. Cutoff scores were identified to correctly classify about 48% of the true positive male and female NSSI cases, with false positive rates of 13.2% and 8.4% for women and men, respectively.