EFFECTS OF WARNING STIMULI FOR REINFORCER WITHDRAWAL AND TASK ONSET ON SELF-INJURY

Results of a functional analysis of self-injurious behavior (SIB) in a child with autism showed that her SIB was maintained by access to preferred objects and escape or avoidance of task demands. Extinction and noncontingent reinforcement treatments were supplemented by presenting a statement combined with a picture cue at 30-s intervals indicating that a preferred object would be removed or a task would be presented. Warning stimuli in combination with extinction and noncontingent reinforcement reduced SIB to acceptable levels. SIB rates remained comparatively high in a control condition consisting of a 2-min delay to onset of reinforcer removal or task demands.     

Continuous Access to Competing Stimulation as Intervention for Self-Injurious Skin Picking in a Child with Autism

Children with autism frequently display self-injurious behavior (SIB), but skin picking—a less severe topography of SIB—has not been the focus of much clinical research. The present study evaluated a home-based intervention that was implemented with a 9-year-old girl who had autism and picked her fingers with resulting tissue damage. The intervention allowed the girl to hold and manipulate preferred objects during play and leisure activities. Evaluated in an ABAB reversal design, intervention essentially eliminated skin picking. Clinical and research implications are discussed.     

THE EFFECTS OF CONTINGENT AND NONCONTINGENT ATTENTION ON SELF-INJURY AND SELF-RESTRAINT

Self-restraint and self-injurious behavior (SIB) are two responses that can sometimes be members of the same functional response class (i.e., maintained by the same contingency). In such cases, a single treatment should be effective for both responses. In this investigation, we examined the effects of providing attention (the presumed reinforcer) both noncontingently and contingent upon either SIB or self-restraint. Results were consistent with our hypothesis that both responses were maintained by attention and suggested that noncontingent reinforcement was a potentially effective treatment.     

Functional analysis of self-injurious behavior and its relation to self-restraint

Some individuals who engage in self-injurious behavior (SIB) also exhibit self-restraint. In the present study, a series of three functional analyses were conducted to determine the variables that maintained a participant's SIB, one without restraint items available, one with a preferred and effective form of self-restraint (an airplane pillow) available noncontingently, and one with this item delivered contingent on SIB. Results suggested that SIB was reinforced by escape and by access to self-restraint materials, self-restraint appeared to be maintained by automatic reinforcement, and continuous access to highly preferred restraint materials effectively suppressed SIB.     

Self-aggression, stereotypy and self-injurious behaviour in man and monkeys

Self-aggression (SA) in monkeys is sometimes referred to as an animal analogue of self-injurious behaviour (SIB) in humans. However, the initiating and maintaining conditions of SA, along with other considerations, make it unlikely that SA can serve as a very useful model of human SIB. Instead, another, more widespread behaviour in nonhuman primates, namely stereotypy, appears to share more in common with human SIB and therefore seems likely to provide a more suitable model. It is concluded that SA is interesting from the point of view of the study of aggression, and that greater understanding of it should have theoretical and practical consequences.     

Treatment of self-restraint associated with the application of protective equipment

The current investigation assessed the effectiveness of protective equipment, specifically arm splints, in reducing the occurrence of severe self-injurious behavior (SIB). Although the protective equipment reduced rates of SIB to near-zero levels, self-restraint subsequently emerged. In an attempt to reduce self-restraint while maintaining reductions in SIB, we provided noncontingent access to preferred stimuli. The presentation of preferred stimuli along with the use of protective equipment reduced both the rate of SIB and the duration of self-restraint.     

AN ANALYSIS OF REINFORCER SUBSTITUTABILITY USING OBJECT MANIPULATION AND SELF-INJURY AS COMPETING RESPONSES

The concept of reinforcer substitutability proposes a continuum of interactions among reinforcers in a given situation. At one end of this continuum, reinforcers are substitutable, with one reinforcer being readily traded for another. We conducted an analysis of reinforcers that were substitutable with those produced by self-injurious behavior (SIB). Three individuals with profound developmental disabilities, whose SIB appeared to be maintained by automatic reinforcement, participated. Results of three experiments showed that (a) object manipulation and SIB were inversely related when leisure materials and SIB were concurrently available, with participants showing almost complete preference for object manipulation; (b) attempts to reduce SIB using the preferred objects as reinforcers in differential reinforcement contingencies were unsuccessful for all 3 participants; and (c) participants' preferences for SIB or object manipulation systematically changed when reinforcer cost (the amount of effort required to obtain the object) was varied. Results of the three experiments illustrate the importance of examining interactions among concurrently available reinforcers when conducting reinforcer assessments.     

A COMPARISON OF NONCONTINGENT REINFORCEMENT AND SENSORY EXTINCTION AS TREATMENTS FOR SELF-INJURIOUS BEHAVIOR

We compared the effects of two treatments, noncontingent reinforcement (NCR) and sensory extinction (EXT), on the self-injurious behavior (SIB) exhibited by 3 individuals with developmental disabilities. Results of a functional analysis indicated that their SIB was not maintained by social reinforcement, as indicated by undifferentiated responding across assessment conditions or higher rates of responding in the alone condition. Prior to treatment, leisure probes were conducted to identify highly preferred items for use in the NCR condition, and equipment probes were conducted to identify devices that produced the greatest behavioral suppression for use in the EXT condition. Following baseline, treatment was implemented in a multiple baseline across subjects design, and the effects of NCR and EXT were compared in a multielement format. During NCR sessions, participants had continuous access to a highly preferred item. During EXT sessions, participants wore equipment (gloves or protective sleeves) that seemed to attenuate stimulation directly produced by their SIB, while still allowing the behavior to occur. Results indicated that both procedures were effective in reducing SIB, although NCR was associated with either more rapid or greater overall response suppression.     

AN ANALOGUE EVALUATION OF ENVIRONMENTAL ENRICHMENT: THE ROLE OF STIMULUS PREFERENCE

To evaluate the effects of environmental enrichment on stereotypic self-injurious behavior (SIB), we conducted an assessment of preference for manipulating alternative stimuli rather than engaging in SIB. First, for each of 3 participants, a functional analysis of SIB was conducted in Phase 1. Participants were selected for Phase 2 if the functional analysis showed that SIB persisted in the absence of social consequences. In Phase 2, a preference assessment was conducted in which participants were observed manipulating preferred stimuli in a free-operant format. A measure was taken of time spent manipulating each stimulus and time spent engaging in SIB. In Phase 3, environmental enrichment was evaluated using stimuli that were preferred over the target response, and alternative treatments were evaluated in the event of environmental enrichment failure. Results suggested that the free-operant preference assessment (a) predicted the efficacy or inefficacy of an environmental enrichment procedure and (b) suggested possible treatment alternatives when environmental enrichment was ineffective. Collectively, the results may provide a basis for interpreting the idiosyncratic effects of environmental enrichment and a rationale for treatment selection when behavioral function is unknown.     

ANALYSIS OF THE REINFORCEMENT AND EXTINCTION COMPONENTS IN DRO CONTINGENCIES WITH SELF-INJURY

Previous research has shown that self-injurious behavior (SIB) maintained by positive reinforcement may be reduced under differential-reinforcement-of-other-behavior (DRO) contingencies. In this study, we conducted an analysis of the reinforcement and extinction components of DRO while treating the self-injury of 3 women with developmental disabilities. A functional analysis revealed that each subject's SIB was maintained by positive reinforcement in the form of attention. Subsequent reinforcer assessments identified preferred and nonpreferred stimuli for later use in conjunction with DRO. Results showed high rates of SIB for all 3 subjects during baseline, which persisted when DRO was implemented without the relevant extinction component (withholding of attention for SIB) for 2 of the subjects. Low rates of SIB were observed for all subjects when DRO plus extinction was implemented or when extinction was implemented alone, suggesting that extinction may be a critical component of DRO schedules.     

TRANSFER OF BEHAVIORAL FUNCTION AS A CONTRIBUTING FACTOR IN TREATMENT RELAPSE

When relapse occurs following successful treatment to reduce problem behavior, it is often attributed to inconsistent implementation of maintenance programs. Although less likely, another potential cause for relapse is a change in the behavior's maintaining contingency over time. To examine this possibility, additional assessment was conducted with 4 individuals who were rereferred to a day-treatment program due to recurrence of their self-injurious behavior (SIB) 2 months to 2 years following successful treatment. In each case, the original treatment had been developed and implemented based on the outcome of functional analysis assessments. For 1 subject, results of a second functional analysis were consistent with those from the original assessment, indicating that the function of her SIB had remained unchanged. For the other 3 subjects, results of the second assessment suggested that their SIB had acquired new or additional functions. These findings indicate that factors other than program inconsistency can lead to relapse, and that clinical revaluation for such cases should include a current functional analysis to determine if new treatment components are needed.     

Problem behavior maintained by a precurrent relation

Differential reinforcement of alternative behavior is a well-established treatment for problem behavior in which the functional reinforcer is delivered after the occurrence of a replacement behavior and withheld after the occurrence of problem behavior. However, sometimes problem behavior continues to occur under these conditions, raising a question as to why problem behavior might maintain when its reinforcer is withheld. This study examined the possibility that problem behavior could be maintained indirectly in a precurrent relation. A functional analysis was conducted to identify a response-response relation between self-injurious behavior (SIB) and an alternative response. The results suggest that SIB was maintained by its relation with the alternative response.     

Self-injurious behavior a biological analysis

A review of self-injurious behavior (SIB) indicates several biological variables that should be considered in future research. A current hypothesis, that SIB is reinforced by attention, receives support but inadequately accounts for evidence that SIB can arise in the absence of reinforcement, is often difficult to modify, and has features unlike those of conditioned behavior. Alternative possibilities are suggested. Neurological damage is common in populations displaying SIB and may produce inadequate pain perception or avoidance. Stereotyped behavior, also common in these populations, may also be related to SIB. Stress and isolation, both strongly correlated with SIB, may evoke this behavior by altering levels of biogenic amines and affecting the probability of aggressive responses. Finally, SIB may have been favored in evolution by group and kin selection, as the loss of a damaged individual may actually favor his genotype through promotion of relatives. These alternatives are not necessarily mutually incompatible nor do they preclude a degree of flexibility in SIB. SIB may result from the interaction of several variables that independently increase its probability.     

ON THE RELATIONSHIP BETWEEN SELF-INJURIOUS BEHAVIOR AND SELF-RESTRAINT

Many individuals who exhibit self-injurious behavior (SIB) also exhibit self-restraint. Three hypotheses about the determinants of self-restraint have been suggested: (a) Self-restraint is maintained by escape from or avoidance of aversive aspects of SIB, (b) self-restraint and SIB are members of the same functional class, and (c) self-restraint and SIB are functionally independent. This study examined a method by which the relationship between self-restraint and SIB may be investigated using functional analysis. Data were collected on the self-restraint and SIB exhibited by 5 mentally retarded males, while conditions suspected to maintain SIB were manipulated. Results suggested that self-restraint, like SIB, may be maintained by idiosyncratic contingencies. Implications of an understanding of self-restraint for the analysis and treatment of SIB are discussed, as are some general possibilities for future research.     

Treatment efficacy of noncontingent reinforcement during brief and extended application

We evaluated the long-term therapeutic effects of noncontingent reinforcement (NCR). In Experiment 1, NCR effects were examined with 2 participants' arbitrary responses; in Experiment 2, NCR was used as treatment with 3 participants whose self-injurious behavior (SIB) was maintained by automatic reinforcement. In both experiments, NCR consisted of continuous access to a highly preferred leisure item and was implemented initially during 10-min and later during 120-min sessions. Varied reinforcers (leisure items) were subsequently introduced during 120-min sessions to determine if treatment effects might be extended. Finally (Experiment 2 only), NCR was implemented throughout the day in participants' homes. Results of Experiments 1 and 2 showed that reinforcers obtained through object manipulation can compete with those obtained automatically by engaging in SIB during brief NCR sessions. However, data from the 120-min sessions indicated that satiation to a specific leisure item might occur over periods of time more typical of those during which treatment would be implemented. Access to a variety of highly preferred leisure items extended the effectiveness of NCR for some individuals. When NCR was implemented throughout the day (Experiment 2), therapeutic effects were shown to be maintained for up to 1 year.     

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.     

EXPERIMENTAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED SELF-INJURY

A functional analysis of the self-injurious behavior (SIB) of 3 adults with profound developmental disabilities showed that each engaged in SIB in more than one assessment condition. Such outcomes may result from a failure to isolate the variable maintaining SIB, or they may reflect multiple sources of control over SIB. In order to identify more clearly the determinants of SIB, each subject was exposed to a series of treatments appropriate to one or both of the apparent functions of SIB. These treatments, applied sequentially on baselines appropriate to each behavioral function, identified the maintaining variables for SIB through differential outcomes across baselines. Results indicated that the SIB of 2 subjects was multiply controlled, confirming the outcomes of the functional analysis. However, the SIB of the 3rd subject was eliminated using a treatment designed for a single function, suggesting spurious results of the original assessment. Alternative interpretations of undifferentiated assessment data are discussed, as are analysis and treatment issues related to multiply determined behavior disorders.     

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.     

Injury characteristics across functional classes of self-injurious behavior

Self-injurious behavior (SIB) is inherently problematic because it can lead to injuries, including those that are quite severe and may result in loss of function or permanent disfigurement. The current study replicated and extended Rooker et al. (2018) by classifying the physical characteristics of injuries across groups of individuals with automatically maintained SIB (ASIB Subtypes 2 and 3) and socially maintained SIB. Individuals with Subtype 2 ASIB had the most frequent and severe injuries. Further, an inverse relation was found between the level of differentiation in the functional analysis and the number of injuries across groups. Studying the response products of SIB (the injuries) documents the risks associated with SIB, justifies the need for research and the intensive intervention, and advances knowledge of SIB. Additional research is needed to replicate these findings, and determine the variables that produce different characteristics of injury secondary to SIB.     

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.