Injury characteristics across functional classes of self‐injurious behavior

Abstract

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.

The consecutive controlled case series: Design, data‐analytics, and reporting methods supporting the study of generality

“…In a CCCS focused on the phenomenology of automatically maintained SIB, Hagopian et al () identified distinct response patterns observed in the FA as the basis for a subtyping model for this functional class of SIB. A subsequent prospective CCCS study showed subtypes differed little with respect to human operant performance (Rooker et al, ), and another showed that individuals with treatment‐resistant subtypes (Subtypes 2 and 3) presented with more severe injuries at the time of admission to treatment relative to those with socially maintained SIB (Rooker et al, ). These studies illustrate how CCCS methodologies can be used to describe and contribute to knowledge on the phenomenology of a clinical problem.…”

“…Second, a prospective CCCS could be conducted by enrolling individuals as research participants and defining the procedures that are applied in accord with the study's predetermined criteria. Examples of prospective CCCS studies include those comparing various functional behavioral assessment methods (e.g., Greer et al, 2019) or those examining the phenomenology of a clinical problem (e.g., Rooker et al, ; ). Prospective CCCS studies conducted outside a program's clinical standard of care would require IRB approval, and informed consent per the U.S. government's OHRP definition of research.…”

“…NCT03995966) involves comparing a newly developed treatment (i.e., combining multiple sources of reinforcer competition targeting SIB, and other components targeting self‐restraint) to NCR with competing stimuli. Given what is known about the severity of these treatment‐resistant subtypes of self‐injury and the risks for injury and increased restraint (Hagopian et al, ; Rooker et al, ), a no‐treatment control condition would not be acceptable.…”

Simplified methods for identifying subtypes of automatically maintained self‐injury

“…According to this subtyping model, automatically maintained SIB that is highly differentiated across the play and no‐interaction conditions of the functional analysis is classified as Subtype 1; undifferentiated SIB is classified as Subtype 2; and when SIB co‐occurs with self‐restraint, it is classified as Subtype 3. Subtypes have been found to differ markedly in terms of outcomes of competing stimulus assessments, response to treatment using reinforcement alone, the need for protective equipment and restraint, and the severity of injuries present at the time of intake (Frank‐Crawford et al, 2023; Hagopian et al, 2018; Hagopian et al, 2015; Hagopian et al, 2017; Rooker et al, 2020).…”

A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model

“…The automatic reinforcers produced by stereotypy may include a wider range of sensory stimulation (positive reinforcement) as well as negative reinforcement. Further, although ASIB should not be considered a homogenous phenomenon, as there is evidence for phenomenological differences in ASIB (Rooker et al, 2020), stereotypy may be an even more heterogeneous phenomenon. A wide breadth of forms of repetitive behavior have been observed to occur in the intellectual and developmental disability population (Bodfish et al, 2000).…”