Tereshko, L., & Sottolano, D. (2017). The effects of an escape extinction procedure using protective equipment on self-injurious behavior. Behavioral Interventions, 32(2),152-159. https://doi.org/10.1002/bin.1475

Reviewed by Mary Jane Weiss, PhD, BCBA-D and Sheila Klick, MS, BCBA, Endicott College

Why research this topic?

Research Synopses topic: Escape Extinction Procedure Using Protective Equipment on Self-Injurious Behavior

Unfortunately, some individuals diagnosed with developmental disabilities may target their own body with forceful actions in a harmful manner, which is commonly referred to in the research literature as self-injurious behavior. Self-injurious behavior, if left untreated, or if treated inappropriately, can result in significant injury to the individual. It is important for caretakers to understand why the individual attempts or acts in self-injurious behavior. Understanding why the individual is likely to engage in self-injurious behavior is a first step toward the development of a treatment plan that effectively decreases this behavior. It is imperative that self-injurious behavior is significantly reduced to maintain the safety of the individual, and to increase teachable moments for the individual to learn. Additionally, protective equipment can help lower the risk of individual injury during treatment. Historically, protective equipment placed on the individual upon self-injurious behavior has been associated with lower rates of self-injurious behavior, although effects may not be lasting and alternatives are needed. It is also important that treatments are effective in everyday settings for the individual (e.g., school/home) and across caregivers (e.g., a variety of staff at the school setting). Finding more community-relevant interventions for self-injury is essential.

What did the researchers do?

The researchers’ first aim was to identify what happens before and after the study’s only participant, Michael, engaged in self-injurious behavior, to gain insight into why he would act in self-harm. Michael was an 8-year old boy, who was diagnosed with autism and a history of attempts or acts to hit his head/neck with open hands, closed fists, or objects hard enough to make noise and cause bruising. Michael received education services in a specialized classroom in a public school. The researchers utilized a specific experimental analysis procedure called functional analysis that has been demonstrated in the research literature to identify which of several possible scenarios is most likely to result in the participant’s self-injurious behavior (Iwata, 1982, 1994). The scenarios in this specific type of analysis include task situations, limited attention situations, and situations in which the individual was alone. These situations were 10 minutes long, and were repeated 4 times each. The researchers used the results of this analysis to develop a treatment plan to address the identified scenario most associated with Michael’s self-injurious behavior, and compared this treatment to the treatment that was previously in place for Michael before this study during his school day.

What did the researchers find?

The researchers found from the experimental analysis that Michael was more likely to demonstrate self-injurious behavior when he was presented with task work he did not prefer. Specifically, Michael was more likely to engage in self-injurious behaviors when asked to do these non-preferred tasks because this resulted in the tasks being temporarily removed (a break from task demand). The researchers determined that the treatment plan prior to the study, which included providing preferred consequences for Michael following task instructions (e.g., a 2-minute break from task for completing a certain number of tasks, which was visually represented with tokens) and physically blocking the self-injurious behavior, should be altered to ensure that Michael did not receive a break from demands as a consequence for hitting his head. To keep Michael safe, the researchers also switched the staff response from physically blocking Michael from hitting his head to Michael wearing a helmet when he engaged in self-injurious behavior. Once Michael was wearing the helmet, the staff would then ask Michael to do simple demands he was able to do without too much effort. Once he completed 3-simple demands, the helmet was removed from Michael’s head. The researchers found that the new treatment plan with the inclusion of maintaining demands and placing a helmet on Michael’s head as a consequence following his self-injurious behavior resulted in a large reduction of Michael’s self-injurious behavior, which maintained over a substantial period of time (18 months).

What do the results mean?

These results have implications regarding the importance of experimental analysis to determine why an individual is engaging in self-injurious behavior in order to develop an effective treatment plan. The results also provide evidence that the use of protective equipment can be combined with other treatment procedures. In this case, equipment was combined with the provision of preferred consequences for completion of tasks and refraining from providing preferred consequences upon demonstration of self-injurious behavior. Future research should explore the effective discontinuation of protective equipment application upon significant reduction of self-injurious behavior and the inclusion of 3 or more participants in an experimental study design to demonstrate the potential for wider application.

Citation for this article:

Weiss, M. J., & Klick, S. (2020). Research synopsis: The effects of an escape extinction procedure using protective equipment on self-injurious behavior. Science in Autism Treatment, 17(10).

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