Academic journal article Education & Treatment of Children

Using a Behavioral Approach to Decrease Self-Injurious Behavior in an Adolescent with Severe Autism: A Data-Based Case Study

Academic journal article Education & Treatment of Children

Using a Behavioral Approach to Decrease Self-Injurious Behavior in an Adolescent with Severe Autism: A Data-Based Case Study

Article excerpt


Individuals with autism spectrum disorder (ASD) are at higher risk for developing self-injurious behaviors (SIB) and other challenging behaviors than typically developing individuals. SIBs often occur owing to deficits in communicative ability and can have undesirable consequences in an individual's environment. This study demonstrated the use of a behavioral training package that included functional communication training (FCT) and a delayed schedule of reinforcement to decrease SIB and another challenging behavior while increasing appropriate requesting for a 14-year-old adolescent male with severe autism. The results demonstrated that the intervention was successful in the child's classroom; however, several limitations exist that practitioners should consider before using similar instructional techniques.

Keywords: autism, challenging behavior, functional communication training, self-injurious behavior


Autism spectrum disorder (ASD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association [APA], 2013) as a condition marked by chronic deficits in social communication and social interactions, as well as restricted, repetitive behaviors, interests, or activities. While a diagnosis of ASD requires that these deficits begin in early childhood, an individual may not exhibit impairment in current functioning until environmental demands begin to outweigh the individual's capabilities (APA, 2013). Features often co-occurring in individuals with ASD include intellectual and/or language deficits, motor deficits, mood disturbances, and disruptive behaviors (APA, 2013).

One specific form of challenging behavior observed in individuals with ASD is self-injurious behavior (SIB; e.g., self-hitting, self-pinching, self-biting) that places them at risk for serious, life-threatening illness as a direct result of self-inflicted bodily harm (Duerden et al., 2012). SIBs are behaviors causing direct physical harm to one's own body, resulting in physical injury and tissue damage (Richman et al., 2013; Wilczynski, Christian, & National Autism Center, 2008), and are considered the most chronic forms of challenging behaviors (Waters & Healy, 2012).

SIBs result in numerous negative consequences for individuals with ASD, as well as their caregivers, family members, and the educational system (Boesch & Wendt, 2009; Sturmey, Seiverling, & Ward-Homer, 2008). Individuals who engage in SIB are often stigmatized and experience peer rejection, sibling disharmony, and rejection by teachers (Sturmey et al., 2008). In fact, SIBs are one of the primary reasons for exclusion from peer-related social activities (Boesch & Wendt, 2009). In addition, studies have shown that SIBs interfere with students' focus on instructional opportunities, thus significantly impacting their educational achievement and future occupational success (Walker & Snell, 2013). Too often, individuals with ASD are placed in exclusionary settings when excessive SIB is displayed, preventing the opportunity for reciprocal social interaction with their peers (Strain, Wilson, & Dunlap, 2011). Clearly, self-injury can negatively impact the quality of life for individuals with ASD (Strain et al., 2011; Walker & Snell, 2013).

Based on survey research and archival data, the reported prevalence rates of SIB for individuals with ASD range from 33% to 71% (McTiernan, Leader, Healy, & Mannion, 2011; Richards, Oliver, Nelson, & Moss, 2012; Richman et al., 2013). Individuals diagnosed with ASD are at a higher risk for developing SIBs than individuals without an ASD diagnosis, and as the level of ASD severity increases, the severity of SIBs also increases (McTiernan et al., 2011; Richman et al., 2013; Waters & Healy, 2012). Richards et al. (2012) surveyed the caregivers of 149 individuals with ASD, fragile X syndrome, or Down syndrome to discover the presence and topography of SIB. …

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