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

Functional Analysis of Self-Injurious Behavior in an Adult with Lesch-Nyhan Syndrome

“…When this participant bit himself during sessions, a nurse or attendant had usually just entered the room. Gilbert, Spellacy, and Watts (1979) and Obi (1997) also reported observing stimulus control over SIB in their participants (i.e., SIB stopped when left alone in the former and increased when feeling anxious in the latter). It would be not all that surprising if our participant had a history of reinforcement of his SIB when in the presence of people who are actively interacting with him, contrasting with lack of reinforcement when alone or with persons who are not paying attention to him.…”

“…When a second treatment component was added, such as differential reinforcement for other (Anderson et al, 1978), alternative (Duker, 1975;Gilbert et al, 1979), or incompatible behavior (Buzas et al, 1981), the reinforcer chosen because of its observed effectiveness was social reinforcement. Obi (1997) also used "lavish" (p. 198) social reinforcement for periods without self-injury. Grace, Cowart, and Matson (1988) eliminated SIB in their participant by withdrawing social attention for undesirable behavior (i.e., time-out) and gave social reinforcement for desirable behavior in their participant; however, their dependent measure was accuracy of self-assessment of self-injury during a preceding time interval rather than the self-injury itself.…”

“…One other study, that by Grace et al (1988), also operationalized their target behavior, attempts at self-biting, as something less than actual SIB, that is, as "movements of the hand toward the open mouth, when the hand was at least at mid-chest level" (p. 56). In other behavioral studies, the risk of serious injury to the participant was managed in other ways, such as beginning with short sessions and increasing session length only when behavioral control was demonstrated (e.g., Grace et al, 1988;McGreevy & Arthur, 1987;Obi, 1997), and by removing only one restraint initially, then removing more restraints only if SIB was controlled (e.g., Anderson et al, 1978;Bull & LaVecchio, 1978). A second unknown parameter introduced by the response-prevention procedure should be noted: the proportion of responses included in the dependent measure that actually would have been SIBs had the responses not been interrupted.…”

Can sensory integration have a role in multi‐element behavioural intervention? An evaluation of factors associated with the management of challenging behaviour in community adult learning disability services

“…Excluded were (a) individuals who resided in an institutional setting, (b) participants whose IQ is above seventy, (c) who have a learning disability but did not display CB, (d) participants aged below eighteen years, (e) studies on medication management, staff training and studies specific to communication, (f) restrictive practice studies where the focus was on those with a mental health condition and/or forensic high‐security psychiatric patient and/or dementia as opposed to learning disability, (g) those with a primary physical disability such as cerebral palsy or those with neurological condition such as brain injury and (h) individuals with a specific diagnosis where the condition is known to cause CB, for example Lesch Nyhan syndrome as it is an inherited metabolic disorder that is characterised by self‐mutilation, such as biting fingers and lips (Obi, ).…”

Further investigation of a rapid restraint analysis

“…One tactic used by researchers and practitioners to mitigate the negative side effects of mechanical restraints, while capitalizing on the beneficial aspects, is restraint fading (Fisher, Piazza, Bowman, Hanley, & Adelinis, 1997). Although the term restraint fading is sometimes used to describe the process of systematically decreasing the time in which an individual wears restraint devices throughout the day (Obi, 1997), it typically refers to a process in which the restrictiveness of a restraint device is systematically decreased (Ball et al, 1980(Ball et al, , 1985Fisher et al, 1997;Kahng, Abt, & Wilder, 2001;Oliver et al, 1998;Paul & Romanczyk, 1973).…”