Academic journal article The Behavioral Development Bulletin

Intervention for Self-Injury in a Child with Autism: Effects of Choice and Continuous Access to Preferred Stimuli

Academic journal article The Behavioral Development Bulletin

Intervention for Self-Injury in a Child with Autism: Effects of Choice and Continuous Access to Preferred Stimuli

Article excerpt

Some children with autism have self-injurious behavior (SIB) such as striking the body with hands or objects, hitting head against a fixed surface, and biting or scratching skin (American Psychiatric Association, 2000; Matson & LoVullo, 2008). The most serious effect of chronic SIB is tissue damage, disfigurement, and health risks due to infection and body trauma. Also, many children with autism and SIB are referred to specialized treatment settings outside of more mainstream educational environments. Regardless of where services are provided, high-frequency SIB interferes with a child's learning and is socially stigmatizing.

Intervention based on the principles of applied behavior analysis has been effective in reducing and sometimes eliminating SIB (Hoch, Long, McPeak, & Rojahn, 2004; Luiselli, in press). The emergence of functional behavioral assessment (FBA) and functional analysis (FA) has made it possible to identify environmental influences on SIB and subsequently formulate an individually tailored treatment plan (Hanley, Iwata, & McCord, 2003). Whereas early intervention research on SIB relied on punishment strategies, more contemporary approaches have emphasized positive behavior-change methods (Luiselli, 2004). In particular, several studies have shown that children's SIB can be treated successfully through antecedent intervention. For example, frequency of SIB has been reduced by presenting pleasurable stimuli non-contingently (Carr & LeBlanc, 2006), eliminating aversive instructional interactions (Miltenberger, 2006), and providing continuous access to preferred stimulation (Ringdahl, Vollmer, Marcus, & Roane, 1997). The therapeutic rationale for these and similar procedures is to influence responding by manipulating the conditions that provoke or set the occasion for SIB (Luiselli, 2006; Smith & Iwata, 1997).

In the present study, we evaluated antecedent intervention for severe SIB in a child with autism. Pre-intervention functional behavioral assessment suggested that the child's SIB was maintained by social and non-social sources of reinforcement. Because an already existing consequence-control procedure was in effect, we sought to reduce the probability of SIB by implementing procedures in a "no demand" context while the child had continuous access to preferred stimuli. The study also evaluated the addition of choice-making as a method of intervention for SIB (Romaniuk & Miltenberger, 2001).


Participant and Setting

Ava was a 7-year old girl diagnosed with autistic disorder. As a consequence of documented child neglect within her biological family, a state agency assumed protective custody and enrolled Ava in a private residential school for students who had developmental disabilities. Ava communicated using single words and physical gestures but her language was difficult to interpret and often repetitive. She had been unresponsive to developmental and intellectual testing, with skills estimated at a 3-4 year old level. Ava required continuous adult supervision to keep her engaged during instruction and to assist her in completing self-care routines. At the residential school she attended a classroom each weekday and lived in a community-based group home.

The most serious problem posed by Ava was high-frequency SIB in the form of striking her face and head with one or both hands. Preliminary measurement before the study indicated that Ava hit or attempted to hit herself in excess of 300 times daily. As a result of chronic SIB, she often had skin abrasions, inflamed areas, and open sores on her face. In an effort to protect Ava from her SIB, staff implemented a response blocking procedure (described below) throughout her waking hours.

In addition to SIB, Ava had a complex medical history including allergies and sleep disturbance. Although she could feed herself, she ate inconsistently during meals and showed erratic food preferences. …

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