eval 1

Behavior Intervention Plan

Alexia Cardona Mercedes Hernandez Cardoso

Anya Marques

Identification of Problem

Target Behavior: Nail Biting

Operational Definition: Defined as any instance in which

an individual places the fingers into the mouth and uses

the teeth to bite, peel, and manipulate the tips of the

fingernails and surrounding cuticle skin. Specific nail-

biting gestures include biting nails down extremely short

past the nail beds, aggressively tearing cuticle skin with

the teeth, and spitting out the removed nail/skin debris.

The behavior prevents nail growth beyond stubs and

causes tissue damage as indicated by sensitivity, redness,

swelling, and occasional bleeding around nail beds on

hands. Episodes of nail biting are scored as a single

response unless at least 60 seconds have elapsed since the

last nail-biting behavior.

Rationale for Intervention: Treatment for

nail biting is being considered due to its

significant impact on physical health,

emotional well-being, and social

functioning. Nail biting can cause damage

to the nails and surrounding skin,

increasing the risk of infections and dental

issues, while also serving as a maladaptive

coping mechanism for stress and anxiety.

This behavior often results in feelings of

embarrassment, affecting confidence in

social and professional settings.

Ethical Considerations

● When conducting the assessment for nail biting behavior, we will ensure informed consent is obtained from participants, clearly explaining the assessment’s purpose and methods.

● We will prioritize confidentiality by securely storing data and limiting access to authorized individuals.

● We will minimize harm by being sensitive to the emotional impact of the assessment process and avoiding any methods that could distress the participant.

● Cultural sensitivity will be important, ensuring that the assessment is respectful and appropriate for the participant's background.

● We will maintain the integrity of the data by ensuring accurate and unbiased collection and reporting of results.

Research Summary 1 The first article selected was “Self-Administered Behavior Modification to Reduce Nail

Biting: Incorporating Simple Technology to Ensure Treatment Integrity” by Craig (2010). The study was conducted to address the issue of chronic nail-biting behavior, which is a common behavior that can persist into adulthood and cause health complications. project.

The study involves a single participant, a male, 21-year-old student, who had engaged in chronic nail-biting. The independent variable was the Differential Reinforcement of Other behavior (DRO) intervention, which rewarded the participant with tokens for nail-biting non-occurrence intervals. The dependent variable was the frequency of nail-biting incidents measured through self- recording. The study used a single-subject reversal design (ABAB), allowing for the observation of behavior changes across baseline and intervention phases.

The results showed a significant decrease in nail-biting frequency during the DRO phases, demonstrating a clear functional relationship between the intervention, behavior change, and the reduction of nail-biting.

Research Summary 2 The second article selected was “The Incidence of Nail Biting Among School Children” by Birch

(1955). The research investigates the prevalence of nail-biting among school-aged children. The study's central goal was to examine how prevalent this habit is and whether it is linked to stress or anxiety.

The study involves participants aged 8-11, primarily drawn from British schools. Although the study focused more on boys, data was also collected for girls. In this study, there was no experimental intervention or manipulation of variables, as the research focused purely on observation of naturally occurring behaviors in the classroom. The dependent variable in the study was the frequency and severity of nail-biting. The behavior was documented by the teachers.

The results revealed that a significant portion of the children engaged in nail-biting behavior, particularly among boys, with over 60% in certain groups. The behavior was less frequent among girls, though still present. The findings suggested a possible link between nail -biting and psychological stress or anxiety, though this was not directly tested.

Research Summary 3 The third article selected was “Nail Biting Behaviour and Its Treatment Through Applied Behaviour Analysis:

A Case” by Bhutto (2013). The research addresses the issue of chronic nail biting (onychophagia) in a 14-year-old girl, emphasizing its frequency during stressful situations and the negative impact on her social life and self-esteem.

The study involves a single participant, a 14-year-old girl from Karachi, Pakistan. The study aimed to determine whether these ABA methods could significantly decrease her nail biting, which had become a source of concern for her and her parents. 1. The independent variable consisted of DRI strategies, which included rewarding the participant for reducing nail biting and implementing consequences for failing to do so. 1. The dependent variable measured was the frequency of nail biting incidents, documented during various phases of the study: pre- intervention, intervention, post-intervention, and follow-ups.

Results indicated a remarkable reduction in nail biting frequency, with a 50% decrease during the intervention phase compared to the pre-intervention period. Although post-intervention levels showed a slight increase, they remained significantly lower than the baseline, suggesting a positive and lasting change.

Baseline & Intervention Graph

Summary of Behavior Assessment The functional assessment of nail biting used frequency data collection, ABC (Antecedent-Behavior-

Consequence) analysis, and the Motivational Assessment Scale II (MAS-II). Over four days, frequency

data established baseline occurrences, averaging 5.75, 5, and 6.5 instances per session. ABC data revealed

triggers like stress and inactivity, with consequences such as temporary relief or sensory stimulation. The

MAS-II indicated the behavior serves two primary functions: escape from stress or aversive tasks and

automatic reinforcement through sensory stimulation. Participant observations confirmed the high

frequency of nail biting in response to specific triggers, highlighting its impact on daily functioning and

guiding intervention planning.

Summary of Treatment Package Antecedent Interventions:

● Non-contingent Reinforcement (NCR): Provide preferred items (e.g., stress balls, fidget toys) at fixed intervals to reduce nail-biting motivation.

● Task Modification: Break lengthy or difficult tasks into manageable parts, reduce durations, or add breaks to minimize aversion.

● Environmental Manipulation: Use sensory items, eliminate triggers, and encourage hand engagement to prevent nail-biting. ● High-Probability Request Sequence: Precede challenging tasks with simple actions to increase compliance and reduce nail-

biting.

Consequence Strategies:

● Positive Reinforcement: Encourage alternative behaviors (e.g., using a fidget toy) with immediate praise or access to preferred activities.

● Reinforcement Schedule: Start with continuous reinforcement (e.g., for 10-minute intervals without nail-biting) and transition to intermittent reinforcement as progress is made.

● Token Economy: Implement a system where tokens earned for refraining from nail-biting can be exchanged for rewards.

Replacement Behaviors: Promote stress-relief techniques (e.g., deep breathing, stress balls), fidget activities, trimmed nails, and deterrents like bitter-tasting nail polish. Encourage mindfulness or hand-focused hobbies like drawing or knitting to redirect behavior.

This comprehensive plan emphasizes preventing triggers, reinforcing alternative behaviors, and fostering self-efficacy while reducing nail-biting.

Analysis of Baseline and Treatment Data Baseline Data: During baseline observation, nail-biting incidents ranged between 3 to 8 per session, with averages of 5.75, 5, and 6.5. The data showed moderate but consistent occurrences of the behavior, suggesting regularity without extreme frequencies.

Treatment Data and Trends: The intervention aims to reduce nail-biting incidents from 15 to 3 or fewer per day over four weeks. Success would be reflected by a decreasing trend in nail-biting incidents and reduced variability over time. Continued variability or lack of progress would signal the need for intervention adjustments.

Results and Barriers: The intervention's effectiveness will be measured by sustained reductions in nail-biting frequency. Barriers include inconsistent reinforcement, fluctuating stress levels, and environmental factors like work or school pressures that may impact outcomes.

Adjustments to Intervention: Potential changes could include increasing reinforcement frequency, enhancing the token economy, tailoring task modifications, or incorporating alternative strategies like habit reversal training.

Conclusion: The intervention’s success hinges on a clear reduction in nail-biting incidents and maintenance of these changes over time. Regular monitoring and data analysis will guide necessary adjustments to ensure optimal results.

References Birch, L. B. (1955). The incidence of nail biting among school children . British Journal of Educational Psychology,

25(2), 123-128. https://doi.org/10.1111/j.2044-8279.1955.tb01345.x

Bhutto, Z. H., & Ali, M. S. Q. (2013). Nail Biting Behavior And Its Treatment Through Applied Behavior Analysis: A Case

STudy. Pakistan Journal of Clinical Psychology, 12(1). https://pjcpku.com/index.php/pjcp/article/view/86

Craig, A. R. (2010). Self-administered behavior modification to reduce nail biting: Incorporating

simple technology to ensure treatment integrity. Behavior Analysis in Practice, 3(2), 38–

41. https://doi.org/10.1007/bf03391763