Study of self-injurious behaviors and the intervention with Functional Communication Training

Self-Injurious Behavior

O Z

University

Self-Injurious Behavior

For this final assignment a research of self-injurious behavior has been conducted. Self-injurious behavior, also known as SIB, is described an instance of behavior that results in physical injury to a person’s own body. SIB includes head banging, using objects to cut or puncture self, pinching self, consuming inedible substances, vomiting, pulling own hair, sucking, biting, scratching body parts and use of drugs, among others (Yang, 2003). SIB, is usually displayed by individuals with autism and intellectual disabilities. SIB can result in serious injuries and in severe cases even death. According to Yang (2003), the treatment of SIB has become one of the most serious issues for clinicians and other professionals due to the injury, risk, prevalence, and cost involved.

Article 1

Overview

The first article discussed is "Combination of extinction and protective measures in the treatment of severely self-injurious behavior" by Lizen Yang from Behavioral interventions journal. Yang explores and discusses the advantages of using extinction in conjunction with the non-intrusive protective measures to treat SIB. In the study, extinction in combination with non-intrusive protective measures was selected as the intervention strategy to reduce SIB.

Subjects and setting

The study was conducted on two adolescent females with profound mental retardation and physical disabilities at a state facility. In this case both subjects exhibited self-injurious behavior (SIB) and had been wearing restrains mechanisms for more than two years to prevent injuries. The treatment sessions were conducted in the morning for one of the subjects and in the afternoon for the other subject in a multipurpose 12’ x 13’room in their residential building. The room contained a table, a desk, and three chairs. Fingernail clippers, a pair of scissors, and a bottle of white petroleum jelly were used, since the target behavior for both subjects was scratching. Soft music at a moderate volume was played during sessions. There also were several activity materials available and placed on the table for participants to access during treatment. Only the therapist and the participant were in the room.

Design and results

Data was collected using event recording during each 30 minute treatment session. Observers used two hand held counters to record the target behavior. In order to constantly analyze data, and monitor the behavior, as well as to avoid medical issues, each treatment session was divided into three 10 minute intervals. Initially a within-subject reversal design was in which baseline (A) and treatment (B) were alternated in an ABAB sequence, but due to frequent and severe self-injuries and for safety reasons, an AB probe design was implemented. During the baseline period, staff were instructed to respond to the target behavior as they normally did. In addition to the continuous application of non-contingent intrusive protective devices, staff was instructed to use verbal instructions to prevent injury. No SIB occurred during baseline because of continuous use of protective measures to prevent injuries. Subjects were given two days in between the baselines and the treatment to allow for healing from any injuries caused during the sessions. During treatment, the subjects’ nails were checked for length and petroleum jelly was applied to their fingertips and target areas. Both subjects’ hands then were guided to touch and manipulate the provided activity materials for about 30 seconds before they were released to start the extinction procedure. During the extinction procedure, no further verbal instructions or physical blocking were used. During extinction, SIB was observed and recorded. No verbal instructions nor physical intervention were employed to stop the SIB.

Internal, External, & Social Validity

The data was displayed on an interval graph that portrayed baseline and treatment. Internal validity was displayed in this study as each graph of the participants in the study show that there was a functional relationship between the use of continuous intrusive measures (Condition A) and non-intrusive measures during treatment (Condition B). The study results showed that extinction was both effective and efficient in eliminating severe SIB. The results also indicated that using the non-intrusive protective measures (petroleum jelly and checking nails) and allowing the target behavior to occur while minimizing self-injuries made it possible to implement the extinction procedure. External validity was also displayed because the intervention was applied effectively on more than one participant. Social validity was also present in this study, as each of the participant’s behaviors were eliminated. This research study was beneficial to subjects involved as the procedure help decrease the need for medical attention, it increased physical freedom from restraints, and even the re-growth of hair on the participants (Yang, 2003). The study results showed that extinction was both effective and efficient in eliminating severe SIB. The results also indicated that using the non-intrusive protective measures (petroleum jelly and checking nails) and allowing the target behavior to occur while minimizing self-injuries made it possible to implement the extinction procedure.

Article 2

Overview

The second article under review is called “Functional analysis and treatment of self-injurious behavior in young children, a summary of 30 cases” from the journal of Applied Behavior Analysis, by Kurtz et al. The authors review the onset of SIB in young children below the age of five and discuss on how to effectively manage this behavior at early stages of development. They further discuss the implications of their findings for the development of early programs of intervention for SIB.

Subjects and Setting

The researchers use 30 children under the age of 5 years, the youngest being 2 years, all of whom had been referred in the period of 3 years for exhibiting severe SIB. 17 f them were boys while 13 were girls. They each were simulated to conditions that acted as stimuli for their SIB. Some of the set conditions included physical attention being given by the caregivers including rocking the child. Another condition set was where the child was not given full attention, that is, the adult was engrossed with another adult talking thus giving the child divided attention, then once in a while reprimanded the child. A third simulated condition was set where the caregiver left the child then returned and reprimanded the child. There were concerns about isolation and therefore conditions were set where none of the children were solely left. Also, normal living conditions like watching TV and house chores and daily activities like personal hygiene were simulated. This way, the typical behavior of the children was able to be studied (Kurtz et al, 2003 ).

Design and Results

Each of the participants were assessed for 2 to 3 hours a day, 2 to 3 days a week for 12 to 16 weeks. Trained staff were placed strategically behind one-way view mirrors to observe the behavioral characteristics of the children during the period of assessment. The room only had the therapist and the child during the periods of assessment.

The data that was received was then constantly and progressively recorded on computers stored for analysis. The data received from the responses was subjected to rigorous analysis by computer programs and output displayed. The mean age for the onset of SIB was found out to be 17 months. The behavioral characteristics were also analyzed and the results calculated as follows. Head banging was found to be the most common and first indicators of SIB with prevalence of about 70% in all the cases that were analyzed. 10% of the participants exhibited self-biting, 6.7% exhibiting body slapping behavior. Body slamming, body slapping and scratching each accounted for 33% of the early signs of SIB in children.

Internal, External and Social validity

The data retrieved from this study was found to be valid in all the three aspects of validity including internal, external and social validities. The internal validity comes in where,87% of the studied participants who exhibited SIB were found to change their behavior with functional interventions. The external validity results from the fact that each of the categories of the children exhibited SIB with environments independent from each other. The social validity comes about where, there was a 43% decrease in the SIB behavior exhibited by the children who participated when the different functional stimuli that aggravated the situation were altered.

Article 3

Overview

Article 3 discusses “Study of Self-Injurious Behaviors and interventions by visual supports” by Kenville. The author studies the causes of SIB in children with autism and further attempts to employ the use of visual aid to reduce the levels of SIB exhibited in these children. The author believes that the use of visual aids with further reduce the SIB particularly in children with autism.

Subjects and Setting

The participant in this survey is a 5-year-old boy with autism (Kenville, 2014). The author investigates the certain behavioral changes that visual aid can impact on the boy by using daily activities of the child. In the setting, the author prefers to investigate these conditions at home. This is the natural habitat of the child and no alterations are made in regard to changing the environment. The author observes the different activities the child engages in over a period of four weeks. The normalcy is applied to both the subject and the parents while the study is underway.

A digital reminder was used however to remind the child of some activities to carry out and some transitions to make, prior to these transitions. These were done during the weeks of intervention only. These aids were meant to be assessed for their impacts on the changing or in this case reduction of SIB behavior being exhibited by the child.

Design and results

The study was conducted over-period of four weeks, the researcher employing an A-B-A-B fashion. Here, the child was subjected to no intervention in the first week, there was intervention by use of the visual aids in the second week. In the third week, the researcher withdrew the aids and then returned the use of visual aids in the fourth week. The results obtained from the observations made were analyzed using baseline data. During the first week which was a non-intervention week, the child exhibited a total of 35 incidences of SIB including running into the wall and hitting the head with objects in his proximity. In the second week, visual aid was deployed to help the child in transitions and carrying out tasks. This is because it had been noted that incidence of SIB came as a result of failure to complete tasks successfully or transition times. During this week, incidences reduced to 22. In the next non-intervention week, cases rose to 26 and in the fourth week they dropped to 22 again with the reintroduction of the visual aids.

Internal, External and Social validity.

Internal validity is obtained since the child shows SIB incidences when they are unable to complete tasks and in the case where they are unable to smoothly transition from one event to the other. The external validity is supported by findings that the same behavior is exhibited by children with autism when they are incapable of performing some tasks successfully. Social validity is attained by the fact that the child shows decrease in SIB behavior with the help of visual aids. This proves the hypothesis of the researcher that implemented use of these visual aids can help reduce cases of SIB in children with autism.

Article 4

Overview

In their article “Self-injury in Autism Spectrum Disorders and Intellectual Overview disability: Exploring the role of reactivity to pain and sensory input”, Savage and her colleagues attempt to explore the possibility that people with Autism have a high likelihood of pain tolerance and therefore more likely to exhibit SIB.

Subjects and setting

Tordjman and his colleagues measured the reactivity to pain of children and adolescents with ages averaging to about 11.7 years with ASD and Intellectual Disorders. This accounted for about 72% of those who were considered to be non-verbal. A control group consisting of 115 children was also used in the study. These children were those without autism. The setting was in a hospital setup where the parents were asked to categorize their children according to their response to life events for instance accidents or illnesses. This same scale was used by the medical research staff to categorize the children under study for their response to pain during medical procedures (Savage et al, 2017).

Design and Results

The heat rate of the children was monitored to see their reactions to pain before and after the procedure. Also, their plasma B- endorphin concentration levels were measured prior to the procedure and after to see their natural reaction to pain. Over half of the children under study with AD exhibited no response to pain. This is because they lacked hypo-reactive responses during the medical procedures. The control group however showed a 39% lack of reaction to pain during the procedure. Heightened reactions were exhibited in 38% of the children with AD as opposed to a higher percentage of 60% in those children without AD.

Internal, External and Social Validity

The internal validity is obtained where a higher percentage of children with autism exhibited no reaction to pain as compared to their counterparts without the disorder. Also, external validity is achieved in the comparison of the different children who had autism since most of them experienced the same reactions to pain but remained silent meaning that the characteristics were shared. Finally, social validity is obtained where there have been other systems of communication evolved to enable the children with autism to communicate their feelings and express emotions.

Article 5

Overview

The article under review is called “Self-Injurious behavior in patients with anorexia nervosa: a quantitative study” by Linda et al. The study aims to quantitatively determine the number of patients with eating disorder who experience SIB. The authors hypothesize that sometimes eating disorders experience frequent emotional instabilities and have high chances of exhibiting SIB.

Subjects and Setting

372 patients in a health facility over 16 years and above participated in the survey. While in the hospital they were issued with questions to find out about their background with an aim of understanding if they experience emotional instabilities thus their likelihood of experiencing SIB. There were no alterations in the setting of the environment since the aim was to find out information about the past and not present circumstances.

Design and Results

The researchers used questionnaires to ask the individual patients about their background experiences with having eating disorder. Some personal interviews were also carried out to determine emotional and psychological states of the participants. 137 of the 362 who participated in the survey returned their questionnaires (Linda et al, 2018). Out of this,41% reported having psychiatric conditions diagnosed. 15% of them had traumatic disorders ,10% had personality disorders and 9% had pressure disorders. These results were obtained from chi-square analysis of the data obtained from the patients.

Internal, External and Social validity.

Most of the patients in the facility showed high likelihood of having SIB thus internal validity. Most of the results obtained were independent of each other yet most of the patient exhibited almost the same types of stigma related issues. This contributes to the external validity. The hypothesis of the writers that most of the people with eating disorders have a likelihood of exhibiting SIB was accepted thus a social validity.

Conclusion

SIB can greatly affect individuals who engage in it. From the purpose standpoint of each study, it presented that SIB can affect individual’s ability to interact with others, it can also make it hard to form relationships, and it has a potential of causing severe injuries if not monitored or targeted. This paper discusses effective, evidence based treatments that help reduce SIB. From non-intrusive measures, to visual aids, to sensory based interventions, we can see that SIB can be addressed, reduced and in cases, it can be completely gone. As behavior analysts, we always look for the safest and less intrusive, effective methods to help our clients. As long as we can remember to create individual plans in our client’s best interest, we can safely implement these.

References

Kurtz, P. F., Chin, M. D., Huete, J. M., Tarbox, R. S., O'Connor, J. T., Paclawskyj, T. R., & Rush, K. S. (2003). Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases. Journal of applied behavior analysis, 36(2), 205–219. https://doi.org/10.1901/jaba.2003.36-205