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

Abstract

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.

Use of a Direct Observational Measure in a Trial of Risperidone and Parent Training in Children with Pervasive Developmental Disorders

“…Alternatively, parents or teachers may compile “counts” of specific behaviors in school or in the home (Cooper et al 2007). Within the ASD and developmental disabilities fields, direct observations have been used to assess treatment efficacy in a wide range of problem areas, from self-injury (Yang 2003), to increasing food acceptance (Ahearn 2002), to eliminating aggression (Kahng et al 2008). Such measures have also been used to assess treatment efficacy in numerous psychopharmacology trials among a range of childhood disorders, especially ADHD (e.g., Abikoff et al 2004; Pelham et al 2002).…”

Self-injurious behaviors, diagnoses, and treatment methods: What mental health professionals are reporting

“…The information that is known about diagnoses come from studies that have been conducted in inpatient settings (e.g., Clarkin et al, 1983;Milnes et al, 2002) or among mentally retarded or developmentally delayed populations (e.g., Yang, 2003). The few outpatient studies that have been conducted involve military recruits (Klonsky, Oltmanns, Turkheirner, 2003), clients with eating disorders (Stein et al, 2004), or have extremely small sample sizes (Yaryura-Tobiaset al, 1995), and typically include self-injury as a secondary variable.…”

Behavioural interventions for self injurious behaviour: a review of recent evidence (1998–2008)

“…Yang (2003) demonstrated variable outcomes using extinction alone; one person showed a near two‐thirds reduction in SIB, whilst another showed only a third reduction in SIB, and a one off, 6‐month follow up, demonstrated that the individuals did not engage in SIB during the follow up observation. Smith et al.…”