Systematic application and removal of protective equipment in the assessment of multiple topographies of self-injury

We evaluated the effects of systematic application and removal of protective equipment on three topographies of self-injurious behavior (SIB) exhibited by a girl who had been diagnosed with autism. Results showed that when protective equipment was applied, SIB decreased to near-zero levels. In addition, withdrawal of protective equipment for specific topographies of SIB (by removing only the corresponding padding) increased rates of SIB only for that topography of SIB. Next, a functional analysis of hand SIB showed that protective equipment suppressed this behavior in all conditions and that the behavior was maintained by automatic reinforcement when padding was removed. Results are discussed in terms of sensory extinction as a possible mechanism responsible for response suppression.     

Combination of extinction and protective measures in the treatment of severely self‐injurious behavior

Two female adolescents with profound mental retardation and physical disabilities residing in a state facility exhibited self‐injurious behavior (SIB). They had been wearing restrictive mechanical restraints for more than two years to prevent injuries from occurring. By using an indirect method of functional analysis, social attention was found to be the factor reinforcing and maintaining their behaviors. Extinction in combination with non‐intrusive protective measures was selected as the intervention strategy to reduce SIB. The outcomes of the treatment were evaluated with an AB probe design. Incidents of SIB decreased quickly and sharply after the treatment began. Once the incidents had reached a level of zero for three consecutive sessions, a six‐month follow‐up was started. No SIB was observed or reported during the follow‐up. The advantages of using extinction, especially in conjunction with the non‐intrusive protective measures to treat SIB, are discussed. Copyright © 2003 John Wiley & Sons, Ltd.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

Rapid assessment of the effects of restraint on self-injury and adaptive behavior

We evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by 2 individuals across eight response-effort conditions: baseline (no restraints); restraint sleeves without stays; restraints with 5, 10, 15, 20, or 25 thin metal stays; and restraints with five thick metal stays. From this analysis, we identified a restraint level for each participant that reduced SIB but did not inhibit adaptive responding.     

Self-injurious behavior in institutionalized,severely/profoundly retarded adults—Prevalence data and staff agreement

Staff agreement on the identification of 18 different types of self-injurious behavior (SIB) and the prevalence of SIB were assessed in a population of 91 severely and profoundly retarded residents in a large facility for mentally retarded people in West Germany (FRG). The survey included 27 direct care staff; groups of three to five rated the behavior of 8 to 27 residents from their own wards. Agreement was calculated with two different formulas for multiple raters. The data suggest that the standard definition of SIB [Tate, B. G.,& Baroff, G. S. (1966).Behavior Research and Therapy, 4, 281–287], together with a list of the most common SIB topographies, yields variable and generally low staff agreement. The data for the prevalence statistics were derived from cases in which at least 50% of the staff had indicated the occurrence of an SIB topography in a resident. Sixty of the 91 residents exhibited some form of SIB; of these, 15 demonstrated only one type, 12 two, and 33 three or more SIB topographies. The data corroborate the notion of the two taxonomic classes of social and nonsocial SIB. Contrary to other classifications the data indicate that ruminative vomiting belongs to the social SIB class.The author wishes to express his gratitude to Dr. Udo Lück, chief psychologist of the Diakoniezentrum Hephata, who made this study possible by his interest and support. The help of Walter Edlinger in collecting the data and of Prof. Hartmann Scheiblechner in giving methodological advice is also greatly appreciated.     

FUNCTIONAL ANALYSIS AND TREATMENT OF SELF‐INJURY IN A CAPTIVE OLIVE BABOON

Self‐injurious behavior (SIB), such as self‐biting and head banging, has been reported to occur in approximately 10% of captive, individually housed nonhuman primates. Accounts of the etiology of SIB in primates range from ecological to physiological. However, to date, no research has examined the possible influence of social consequences delivered by handlers and keepers in the maintenance of SIB in this population. The current study investigated the effects of social contact as a potentially reinforcing consequence for the SIB displayed by an olive baboon (Papio hamadryas anubis). Results indicated that the behavior was maintained by attention from humans. As treatment, reinforcement was arranged for an appropriate alternative response, resulting in increases in the appropriate alternative behavior and decreases in SIB.     

PROTECTIVE EQUIPMENT: CONTINUOUS AND CONTINGENT APPLICATION IN THE TREATMENT OF SELF-INJURIOUS BEHAVIOR

This study evaluated the use of protective equipment in treating self-injurious behavior (SIB) exhibited by three retarded persons. In Experiment 1, the equipment was first applied continuously during 20-min sessions in individual multiple baseline designs across settings. Results showed substantial reductions in head hitting, eye gouging, and hand biting. Brief periods of time-out with the protective equipment were later made contingent on SIB and combined with a differential reinforcement procedure. Reduced levels of SIB was maintained with all subjects. Additionally, the amount of time during which the equipment was applied decreased as the SIB diminished. Experiment 2 evaluated the use of contingent protective equipment (the final condition in Experiment 1) when applied directly in the subjects' living uints during the day. During Experiment 2, SIB remained at or below the levels found at the termination of Experiment 1. Finally, in an effort to assess the long-term effectiveness of the procedure, responsibility for implementation was given to the staff who were typically assigned to provide therapy to the subjects. Follow-up probe observations conducted up to 104 days after termination of the final experimental condition showed continued low levels of both SIB and equipment usage. Results of these experiments suggest that contingent protective equipment and differential reinforcement may be effective in reducing chronic self-injury.     

Self‐restraint and self‐injury: a demonstration of separate functions and response classes

We evaluated the self‐injurious behavior (SIB) and self‐restraint (SR) of an 11‐year‐old boy with severe mental retardation that were suspected to be functionally unrelated. A functional analysis (consequences provided for SIB) resulted in near‐zero levels of SIB across experimental conditions and did not indicate a specific function of SIB. In contrast, high, undifferentiated levels of SR were observed during the attention, control, alone, and demand conditions. Further analysis of a possible tangible function of SIB using pairwise comparisons resulted in a high rate of SIB during the contingent tangible condition, no SIB in the noncontingent tangible condition, and comparable levels of SR in both conditions. A subsequent analysis using restraint blocking during play and no‐play contexts suggested that SR produced automatic reinforcement under conditions of low ambient stimulation. Thus, SIB and SR were shown to be functionally independent and maintained by distinct consequences. The results are briefly discussed and suggestions for future research are provided. Copyright © 2000 John Wiley & Sons, Ltd.     

Decreasing self‐injurious behavior associated with awakening in a child with autism and developmental delays

Direct observation data revealed that self‐injurious behavior (SIB) emitted by a young boy with autism occurred primarily within one hour after waking versus all other times of the day. Experimentally manipulated scheduled awakenings supported the hypothesized relation between waking and SIB. A faded‐bedtime procedure was then implemented to stabilize his sleep patterns, which reduced awakenings by 81% and post‐waking SIB by 82%. Copyright © 2004 John Wiley & Sons, Ltd.     

Restraint fading and alternate management strategies to treat a man with Lesch–Nyhan syndrome over a 2 year period

In this study the variables maintaining self-injury and the use of wrist restraints in a man with Lesch–Nyhan Syndrome were identified through a pre-treatment functional assessment. In phase I, the client's self-injury and use of wrist restraints were treated by his participation in a relaxation training class and substituting his wrist restraints with a hockey-type head helmet in order to reduce self-injury and dependency on the use of wrist restraints and increase functional use of his hands. In phase II, a restraint fading procedure was implemented. This consisted of removing his restraints twice daily for 20 min and engaging him in hand over hand training. This was done in order to systematically reduce the amount of time the subject spent in restraint. In phase III, generalization was implemented across settings including work and home and across different staff persons. In phase IV, skills shaping was used to train the subject to use his hands to engage in and improve his activities of daily living. The results demonstrate a decrease in restraint use and an increase in adaptive and social experiences and reductions in challenging behaviors over a 26 month period. © 1997 John Wiley & Sons, Ltd.     

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.     

Further analysis of subtypes of automatically reinforced SIB: A replication and quantitative analysis of published datasets

Hagopian, Rooker, and Zarcone (2015) evaluated a model for subtyping automatically reinforced self‐injurious behavior (SIB) based on its sensitivity to changes in functional analysis conditions and the presence of self‐restraint. The current study tested the generality of the model by applying it to all datasets of automatically reinforced SIB published from 1982 to 2015. We identified 49 datasets that included sufficient data to permit subtyping. Similar to the original study, Subtype‐1 SIB was generally amenable to treatment using reinforcement alone, whereas Subtype‐2 SIB was not. Conclusions could not be drawn about Subtype‐3 SIB due to the small number of datasets. Nevertheless, the findings support the generality of the model and suggest that sensitivity of SIB to disruption by alternative reinforcement is an important dimension of automatically reinforced SIB. Findings also suggest that automatically reinforced SIB should no longer be considered a single category and that additional research is needed to better understand and treat Subtype‐2 SIB.     

An economical,humane, and effective method for short—term suppression of hand mouthing

Self-injurious behavior (SIB) is a serious health hazard, especially among individuals with severe and profound mental retardation, sometimes leading to drastic therapeutic measures. Environments in which there are long periods with minimal opportunities for constructive activity are conducive to the development of SIB, but even highly motivated, hard-working caregivers sometimes have difficulty providing sufficient personal interactions to prevent it. In this case study, one person's self-injurious hand mouthing was significantly reduced by analyzing her toy play and consistently providing her with preferred toys. The results showed that careful and consistent attention to assuring that preferred materials are available for self-entertainment may be an effective and efficient method for managing some cases of SIB during times when other activities and treatments are unavailable.     

Functional analysis of self‐injury maintained by automatic reinforcement: exposing masked social functions

Two functional analyses for self‐injurious behavior (SIB) exhibited by a child diagnosed with mental retardation and autism were conducted. Responding was high and undifferentiated in the first functional analysis, indicating that SIB was maintained by automatic reinforcement. During the second functional analysis, the client wore a padded helmet and all SIB was blocked. SIB decreased in all conditions except attention, suggesting that SIB was multiply controlled (social positive and automatic reinforcement). Copyright © 2001 John Wiley & Sons, Ltd.     

COMPUTER‐ASSISTED MEASUREMENT OF WOUND SIZE ASSOCIATED WITH SELF‐INJURIOUS BEHAVIOR

We evaluated an inexpensive, efficient, and noninvasive technique for measuring tissue damage produced by self‐injurious behavior (SIB). The technique involved computerized measurement of wound surface area (WSA) based on digital photographs. In Study 1, we compared photographic measurement to a more commonly used procedure, transparency measurement, in estimating WSA of 20 wound models. Results showed that both methods were reliable and that there was a high degree of correspondence between the 2 sets of measures. In Study 2, we compared photographic WSA measures to direct‐observation measures in documenting changes over time in the SIB exhibited by a woman with Prader‐Willi syndrome. Results showed that increases and decreases in observed SIB during baseline and treatment conditions corresponded with changes in WSA measures, indicating that the computer‐assisted photographic technique may be useful as a corroborative measure or as a primary measure when direct observation of SIB is not feasible.     

Selfish power and unselfish status in Chinese work situations

The present research explored the selfishness of power and status as well as the mechanism in Chinese work situations. By using experimental and survey methods, two studies were designed to investigate the relationships among power, status, and self‐interested behaviour (SIB) as well as the mediating effect of perspective‐taking (PT). Results of the two studies consistently indicated that power increases whereas status reduces SIB. These opposing behavioural effects are partially attributed to the fact that power reduces whereas status increases PT. In addition, our results showed an interaction between power and status on SIB in Study 1 (interaction as a mental function), and a positive correlation between perceived power and status in Study 2 (correlation as a mental perception). Through the discussion from the perspective of the self/other‐orientation trait, as well as the stable effects of power and status on SIB in the two studies, we conclude that power is selfish and status is unselfish in Chinese work situations.     

Psychiatric and Self‐Injury Profiles of Adolescent Suicide Attempters versus Adolescents Engaged in Nonsuicidal Self‐Injury

To better delineate the unique correlates of self‐injurious behaviors (SIB), psychiatric profiles of mutually exclusive groups of adolescents who made a suicide attempt (SA) versus those engaged in nonsuicidal self‐injury (NSSI) were examined. Contrary to hypotheses, the NSSI group endorsed earlier onsets of SIB and suicidal ideation (SI), as well as higher rates of depression and anxiety compared with their SA counterparts. Future work is warranted to understand the role of SI, including duration of SI and anxiety in the development of NSSI, and to identify risk and resiliency factors useful in predicting an adolescent's SIB status.     

WHAT MAKES EXTINCTION WORK: AN ANALYSIS OF PROCEDURAL FORM AND FUNCTION

We examined methods for determining how extinction should be applied to different functions of self-injurious behavior (SIB). Assessment data indicated that the head banging of 3 children with developmental disabilities was maintained by different reinforcement contingencies: One subject's SIB was positively reinforced by attention from adults, the 2nd subject's SIB was negatively reinforced by escape from educational tasks, and the 3rd subject's SIB appeared to be automatically reinforced or “self-stimulatory” in nature. Three functional variations of extinction—EXT (attention), EXT (escape), and EXT (sensory)—were evaluated, and each subject was exposed to at least two of these variations in reversal or multiple baseline designs. Reductions in SIB were observed only when implementation of “extinction” involved the discontinuation of reinforcement previously shown to be responsible for maintaining the behavior. These results highlight important differences among treatment techniques based on the same behavioral principle (extinction) when applied to topographically similar but functionally dissimilar responses, and further illustrate the practical implications of a functional analysis of behavior disorders for designing, selecting, and classifying therapeutic interventions.     

DECREASING SELF‐INJURIOUS BEHAVIOR AND FADING SELF‐RESTRAINT IN A STUDENT WITH AUTISM AND TOURETTE SYNDROME

This clinical case study was conducted with a student diagnosed with autism and Tourette syndrome who displayed severe self‐injurious behavior (SIB). Behavioral assessments and observations suggested that the student demonstrated less SIB during a self‐restraint, where he wrapped his hands tightly in a large blanket. We used an ABAB design with fading to reduce the size of the blanket to keep rates of SIB low. In addition, we also used a fixed interval reinforcement schedule and extinction during the intervention/restraint phases. Results indicated that the student maintained near‐zero rates of SIB for 6 months after use of the blanket was eliminated. Results and implications for practice and future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

ANALYSIS OF SOCIAL VARIABLES WHEN AN INITIAL FUNCTIONAL ANALYSIS INDICATES AUTOMATIC REINFORCEMENT AS THE MAINTAINING VARIABLE FOR SELF‐INJURIOUS BEHAVIOR

Self‐injurious behavior (SIB) that occurs at high rates across all conditions of a functional analysis can suggest automatic or multiple functions. In the current study, we conducted a functional analysis for 1 individual with SIB. Results indicated that SIB was, at least in part, maintained by automatic reinforcement. Further analyses using protective equipment (i.e., a helmet with face shield) revealed an attention function for the SIB.