SELF-INJURIOUS AND PROBLEM 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. Treatment of SIB is largely pharmacological (biomedical model), behavioral (learning theory) or a combination of both approaches.
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
The following information is obtained from the FBA (ABCs):
- 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
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 INTERVENTIONSNoncontingent reinforcementRemoval of attention from SIB Teaching functionally equivalent behaviorsDifferential reinforcementTime-outTolerance for delay
BAD INTERVENTIONS
Verbal reprimands
IF person has SIB to get out of working or a social situation:GOOD INTERVENTIONSNoncontingent reinforcement Not allowing escape following SIB Task 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- competing items- enriched environments Removal of sensory stimulation provided by SIB (e.g., protective equipment)Response blockingDifferential reinforcement
BAD INTERVENTIONS
Verbal reprimands
Time-out
Courtesy of: Johanna Lantz, PhDAgency: Columbia University Medical CenterWebsite: www.newyorkautism.columbia.eduEmail: lantzj@childpsych.columbia.eduPhone: 212-305-4360
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