SELF-INJURIOUS BEHAVIOR MANAGEMENT
What
are Self-Injurious Behaviors (SIB)?
SIB are acts directed towards oneself that can
result in tissue damage (Tate & Baroff 1966). Among persons with developmental
disabilities, the most frequent forms of SIB are (Rojahn 1994) head
banging, biting self, scratching self and hitting self with objects.
Importance
of SIB Management
Among persons with mental retardation, the prevalence
ranges from 1.7% for those in the community to 28% for those in residential
placement. SIB is a leading reason for restrictive special educational
programming, hospitalization, and residential placement. Possible medical sequelae include cauliflower
ear, cataracts, retinal detachment, infection, fractured bones, tissue scarring
or loss.
Treatment
of SIB in 2008 Is Largely
- Pharmacological (biomedical model) based on the rationale that SIB may be
caused by an underlying neurochemical imbalance, altered pain sensitivity, or
primary psychiatric disorder
- Behavioral (learning theory) based on the rationale that SIB occurs in
response to specific antecedent stimuli that predict the occurrence of
desirable consequence of the behavior, e.g., escape from tasks or obtaining
social attention or tangibles
- A combination of approaches may also be used
ASSESSMENT
OF SIB
The
Behavioral Perspective: Why Problem Behaviors Occur
- Problem behaviors may be easier to display due to communication and other
skill deficits
- Problem behaviors may be reacted to more frequently, with more intensity,
or longer duration
- Problem behaviors get the person what he/she wants
Common
Reactions to Problem Behaviors
- Attention (“Stop that!”; “You’re going to hurt yourself!”)
- Give individual an item to calm them down
- Allow a break from an activity to “calm down”
-
Avoid disrupting a child’s routine to “prevent” a behavior
These
reactions may make the behaviors worse depending on the “function” or purpose
of the behavior for the person.
What
is Functional Behavioral Assessment (FBA)?
- A method by which the functions of a behavior (or variables that maintain
that behavior) are determined, OR, in other words …A method that identifies why
a person displays a particular behavior
ABCs
The
following information is obtained from the FBA:
- Antecedent-Trigger: What happened immediately before?
-
Behavior
- Consequence: What was the reaction to the behavior?
- Setting Events: Environmental, physical, or interpersonal factors that make it more
likely that an antecedent will result in a problem behavior
Behavioral
Functions
Behaviors
are a form of communication and serve a “function” or purpose for the person.
The following are examples of why a person may engage in SIB:
- Social-Positive Reinforcement - To gain access to attention, tangible
items, or food
- Social-Negative Reinforcement - To escape/avoid task demands, social interaction, or
stimulation
- Automatic Reinforcement - For sensory stimulation or pain attenuation
TREATMENT
OF SIB
Why
Do We Need to Know the “Function”?
-
Helpful to develop more effective treatments
- Prevent counterproductive interventions
IF
person has SIB to gain access to preferred items or attention:
GOOD INTERVENTIONS
- Noncontingent reinforcement
- Removal of attention from SIB
- Teaching functionally equivalent behaviors
- Differential reinforcement
- Time-out
- Tolerance for delay
BAD INTERVENTIONS
IF
person has SIB to get out of working or a social situation:
GOOD INTERVENTIONS
- Noncontingent reinforcement
-
Not allowing escape following SIB
- Taks modification
- Demand fading
- Teaching replacement behaviors (e.g., ask for break or
help)
- Differential reinforcement
BAD INTERVENTIONS
- Verbal reprimands
- Allowing person out of a demand following SIB
- Time-out
IF person has SIB for sensory
stimulation or pain attenuation:
GOOD INTERVENTIONS
-
Noncontingent reinforcement
-
Removal of sensory stimulation provided by SIB (e.g., protective
equipment)
-
Response blocking
- Differential reinforcement
BAD INTERVENTIONS
- Verbal reprimands
- Time-out
Protective
Equipment
- In cases of severe SIB, use of protective equipment may be necessary head
gear (e.g., sparring gear), arm splints, padding, gloves
- Should be faded out
- Should be removed if possible on a regular basis to allow skin to breathe
- Should be used with other function-based approaches
Courtesy
of Johanna Lantz, PhD, Columbia
University Medical Center, New York, NY
212-342-1600,
lantzj@childpsych.columbia.edu
All
Rights Reserved
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