Data Bases • Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism? Links • Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com Free Essays • Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers	Search Lots of Essays Back to Subjects - Philosophy Decreasing self injuring behavior Decreasing self injuring behavior Decreasing self-injurious behavior(s) Self-injurious behavior refers to repeated responses made by individuals that are directed toward themselves and result in tissue damage or physical harm. Self-injurious behavior (SIB) is found in some individuals with severe mental retardation, but it is a characteristic most often associated with multiple disabilities. Nevertheless, some children and youths with normal intelligence and language skills indulge in SIB. The intent usually is to injure themselves without killing themselves. Topographies of SIB include, but are not limited to: mouthing, hand biting, head banging, and skin tearing. The resultant injuries vary from mild abrasions to extensive scarring. Many different approaches to reducing SIB have been tried. No approach has been entirely successful, although some show better results than others. The major contribution to effective interventions for SIB has come from the field of applied behavior analysis. Interventions range from mildly intrusive to more drastic techniques such as electric shock. The focus of this paper will be on effective methods used for reducing self-injurious behavior. When trying to decrease a behavior such as self-injury, the first question to ask yourself is, "What behavior can I increase?" It is important to find a functional, alternative behavior to reinforce which will stop or weaken the target behavior. A behavior is a functional alternative if it successfully serves the same function as the original behavior (Alberto & Troutman, 1991, p. 278). Differential reinforcement is the least intrusive alternative to decreasing undesirable behavior. There are four types of differential reinforcement: differential reinforcement of incompatible behavior (DRI), differential reinforcement of other behavior(s) (DRO), differential reinforcement of lower rates of behavior (DRL), and differential reinforcement of alternative behavior(s) (DRA). DRI is reinforcing a behavior that is incompatible with the behavior targeted for reduction. When an individual is exhibiting a behavior such as head slapping, a DRI could be giving the individual a tennis ball to roll back and forth between his or her hands. This behavior is incompatible because a person cannot roll a ball between their hands and slap their head simultaneously. Positive reinforcement such as "good playing" could be given along with the DRI. The advantage to using DRI is that it allows the appropriate behavior to occur and also decreases the probability of the undesirable behavior. DRO, sometimes referred to as differential reinforcement of zero rates of behavior, involves the presentation of a reinforcing stimulus contingent on the nonoccurrence of the behavior. Some individuals exhibiting SIB may pick at their skin or bite themselves. This behavior can leave the person with mild abrasions, scabs, or scars on his or her skin. Using the DRO technique, reinforcement should be given for every behavior except the target behavior. This means that the individual can be exhibiting many other undesirable behaviors, but they will only be reinforced if they do not exhibit the target behavior. The observer could make a statement such as, "If you can go 30 minutes without skin picking or biting, you may have a candy bar at the end of the 30 minute session." If the subject picks or bites him or herself at any time during the 30 minute session, they will receive no reward. The effectiveness of this procedure depends on the reinforcer selected. The reinforcer must be equal to or exceeding the reinforcer that is currently maintaining the undesirable behavior. DRL is the reinforcement of lower rates of behavior. This technique can be used to decrease a behavior to a more tolerable level. An individual exhibiting self-stimulatory behavior such as hand mouthing (inserting fingers or hand into the mouth) may be causing damage to him or herself. Although it may not be seriously detrimental, it could chafe the individual's skin to the point of bleeding. Using DRL, this undesirable behavior could be lowered to the point that it is not causing skin damage. The individual is reinforced when the number of responses in a specified time period is equal to or less than the assigned limit. If the subject normally exhibits hand mouthing 35 times in a 10 minute time frame, set up a reward system for them if they exhibit the behavior 15 times or less within the 10 minutes. Once this behavior has stabilized, the criterion can be changed to a lower rate of behavior. The differential reinforcement of alternative behavior(s) (DRA) is the least effective of the four techniques. DRA is similar to DRI in the fact that they both reinforce the behavior that is alternative to the behavior targeted for reduction. With the DRA procedure, the target behavior and the alternative behavior are dissimilar but not necessarily physically incompatible. Each time the subject attempts SIB they are redirected to the performance of the alternative behavior, which is then reinforced. Habit reversal is another nonintrusive intervention to SIB. It is the process of making the individual aware of the undesirable behavior or habit and trying to reduce or eliminate that behavior. Some of the most common nervous habits are skin picking, lip biting, and hair pulling. A simplified version of habit reversal could include awareness training, competing response training, relaxation, and social support. A study was done on an individual that exhibited lip biting with such intensity that his mouth would fill with blood. To make the subject aware of the frequency of his lip biting, he was asked to carry a white handkerchief in his pocket. He was to dab his lip with it each time he had a biting episode. He was told to use a clean spot on the handkerchief each time. At the end of the day he would put the handkerchief in a zip lock bag. The next day he would get a fresh handkerchief. During the baseline the frequency of lip biting was between four and thirty-five blood spots per day. During intervention, frequency was nine the first day and zero for the remaining thirteen days. Intervention contained two components of habit reversal. The first was relaxation, which included diaphragmatic breathing (deep, slow breathing from the belly), and progressive muscle relaxation (i.e., tensing muscles for five sec then releasing). Relaxation self-statements were also used (e.g., "My body is calm, quiet, and relaxed"). The second component was competing responses, such as gum chewing and/or tongue to lip rubbing. Using an ABAB design, results showed rapid reduction to zero rates during treatment. A two-month follow-up exam showed no evidence of irritation or biting and substantial evidence of healing (Friman, Jones, Swearer, 1997, p. 697-699). Extinction is defined as the withholding of reinforcement for a previously reinforced behavior to reduce the occurrence of the behavior. Many inappropriate behaviors are maintained by positive reinforcement. SIB could be reinforced by social attention from others. A child who head bangs and gets adult attention (even if it is a reprimand) will most likely continue to head bang. With extinction, the idea is to ignore the undesirable behavior and reinforce more appropriate behaviors. Once the individual realizes there are no reinforcers to maintain their behavior, the behavior may decrease or go away completely. Social consequences are not always the objects of reinforcement. Some students exhibiting SIB may do so because it feels good or it is fun to do. In such instances a sensory consequence may be maintaining the behavior (i.e., self-scratching may be maintained by the tactile input resulting from the behavior). This behavior could be reduced by covering the area with heavy petroleum jelly, which eliminates the tactile consequence of the behavior. There are some drawbacks with extinction such as a delayed reaction and/or lack of generalization. The individual continues to seek the reinforcer and it may take time to see any results. There is usually an increased rate and/or intensity of the behavior before any reduction results are present. In other words, it is going to get worse before it gets better. Once extinction is successful in one setting there is no guarantee that it will generalize into another setting. Therefore, programming extinction may be required in all necessary environments. Response Cost is the removal of a previously earned reward or reinforcer contingent upon specific inappropriate behavior. Minutes of recess, free time, or access to another preferred activity or points toward earning a reinforcing item or activity may be lost for each misbehavior (Kauffman, 1997, p. 355). Response cost is a punisher which is the least likely to generate strong emotional side effects or resistance. A punisher is a consequent stimulus that decreases the future rate and/or probability of occurrence of behavior. Punishment should be delivered contingently upon the exhibition of the inappropriate behavior and it must be immediate. A punisher can be identified only by its effect on the behavior. If the behavior does not decrease or stop upon the administration of a punisher then it is not considered to be a punisher for that individual. A young man with severe mental retardation exhibited SIB which consisted of fist-to-head hitting and head banging. This self-injury resulted in tissue damage in the form of scarring, bleeding, and bruising to his hands, wrists, and head. The behavior was being maintained by attention from an adult. Response cost was used to decrease the occurrence of SIB. A therapist was placed in a room with the young man. The therapist and he would play games or indulge in brief conversation. The therapist gave him social reinforcement for appropriate behaviors and the nonoccurrence of SIB. If the subject engaged in SIB, the therapist would leave the room, therefore, eliminating the possibility for reinforcement (Adelinis, Fisher, Hanley, Piazza, 1997, p. 251-260). A time-out is a procedure that serves as punishment by denying a student, for a set period of time, the opportunity to receive reinforcement. It is also known as a time-out from positive reinforcement. There are three types of time-out procedures that are categorized by the method of denying access to reinforcers. A nonseclusionary time-out denies the student access to reinforcers by temporarily manipulating the environment. The student is still present in the room but may be moved to another table and required to put his or her head down on the table. An exclusionary time-out involves removing the student from the activity and away from reinforcement. The student may be moved to another part of the room or may be removed from the room completely. When a student is moved to another part of the room he or she could be instructed to sit in a chair facing away from their peers or be placed behind a screened-off area. On the other hand, if the student is removed from the classroom completely, he or she may be asked to sit in a study room alone or with an accompanying adult. During a seclusionary time-out, a time-out room is used. This room is a means for isolating the student contingent upon misbehavior. This eliminates access to reinforcement from teachers and peers. A strict guideline must be followed for the use of exclusionary and seclusionary time-out procedures. Minnesota Rule on Time-Out Procedures Time-out procedures that seclude a student in a specially designated isolation room or similar space must meet the following conditions: specific criteria for returning the pupil to the routine activities and regular education environment; an evaluation to determine whether seclusion is contraindicated for psychological or physical health reasons; provision for the pupil to be continually monitored by trained staff; adequate access to drinking water and to a bathroom for a time-out that exceeds 15 minutes; documentation of the length of time spent in each time-out procedure and the number of occurrences each day. Time-out procedures can be effective in reducing self-injurious behavior(s) if the behavior(s) is maintained by social reinforcers such as teachers and/or peers. This procedure would not be effective if the individual exhibits SIB when in isolation. An aversive stimulus is a stimulus that decreases the rate or probability of the behavior when presented as a punishing consequence. These types of procedures should be used only when safety is jeopardized or in cases of extreme behavior problems. Interventions that are less intrusive should be tried first. An unconditioned aversive stimulus is the result of physical pain or discomfort to the student (e.g., pinching or slapping). This class of stimuli includes anything that causes pain: naturally occurring consequences, such as contact with a hot stove, or contrived consequences, such as the application of electric shock (Alberto & Troutman, 1999, p. 310). The application of an aversive stimulus rapidly stops the occurrence of the behavior and may have long-term effects. Noxious Stimuli. Mild aversives such as noxious stimuli are considered to be unconditioned. These stimuli result in irritation, discomfort, and annoyance rather than pain. Water, lemon juice, and aromatic ammonia have all been used as aversive consequences. A study was conducted on a 20-year-old autistic woman who slapped herself repeatedly in the head. The slapping was sometimes accompanied by vocalizations and screams, but her verbalization was limited to only a few words when candy reinforcers were available. When the study began, the subject wore a helmet all day and her arms were restrained to her chair. She would occasionally take her helmet off and slap her head until staff physically restrained her again. Unless she was under constant observation, she would eat her own feces and urine. The baseline rates of SIB ranged between 35 and 60 slaps per minute. Intervention included crushing an ammonia capsule and thrusting it under the subject's nose when she slapped herself and withdrawing it when she stopped. The rate of slapping during this phase ranged from 0.4 to 3 per minute. During return to baseline, the rate recovered to a mean of 42.5 slaps per minute. Re-intervention reduced SIB to zero occurrences (Tanner, Zeiler, 1975, p. 53-57). Although using noxious stimuli was proven to be effective in a clinical setting, it is unlikely that it would be used in a public school setting due to its drastic nature. An aversive stimulus such as physical restraint would be a more appropriate intervention in a school setting. Restraint. There are three categories of restraint: personal restraint, mechanical restraint, and self-restraint. Personal restraint is defined as movement suppression by the application of force or pressure by one person upon another, the most common being the baskethold. Mechanical restraint involves the use of a device such as arm splints to immobilize the individual. Some individuals that engage in SIB may need to be placed in arm splints to keep them from seriously hurting themselves. A self-restraint involves the individual restricting his or her own movements, such as sitting on hands or wrapping arms in clothing. All three types of restraint have been used successfully in decreasing SIB. Using unconditioned aversive stimulus can be effective when used properly. Bare in mind, these procedures may not work in every case; some individuals may find the procedure(s) reinforcing rather than punishing. Professional literature on the procedure(s) should be read thoroughly before recommending or implementing its use. A conditioned aversive stimulus is a stimulus that is learned by pairing the stimulus with an unconditioned aversive stimulus. An example would be an individual receiving a verbal reprimand such as scolding accompanied by a firm grasp of his or her arm. The unconditioned stimulus (firm grasp) has been paired with the conditioned stimulus (scolding). Overcorrection is a behavior reduction technique that includes training in appropriate behaviors. Restitutional Overcorrection. This procedure is implemented by requiring an individual to restore or correct an environment that they have disturbed. Not only does the environment have to be restored to its original condition, it has to go beyond that. If a student is engaging in a SIB such as skin biting to the extent that blood is drawn and dripping on the floor; the student should not only have to mop up his or her own blood, but be required to mop up all the floors. This could be an example of restitutional overcorrection. There are many different topographies to self-injurious behavior(s) and various reinforcers that are maintaining the behavior(s). The key to decreasing such behaviors is to first try to increase more appropriate behaviors. This can be done by using less intrusive interventions such as differential reinforcement and extinction and then, if necessary, implementing more intrusive interventions such as response cost and time-out procedures. Finally, as a last resort, the presentation of an aversive stimulus can be used for decreasing the target behavior. NOTE: When using any of the above-mentioned interventions, it is important that a person be properly informed of and trained in the procedure before recommending or implementing use of that procedure. Bibliography: References Adelinis, J.D., Fisher, W.W., Hanley, G.P., & Piazza, C.C. (1997). Stimulus control and resistance to extinction in attention-maintained sib. Research in Developmental Disabilities, 18, 251-260. Alberto, P.A., & Troutman, A.C. (1999). Applied behavior analysis for teachers. (5th ed.). Upper Saddle River, NJ: Prentice-Hall, Inc. Day, J.R., Day, M.H., & Horner, R.H. (1997). Using neutralizing routines to reduce problem behaviors. Journal of Applied Behavior Analysis, 30, 601-614. Dorsey, M.F., Iwata, B.A., McSween, T.E., & Ong, P. (1980). Treatment of self-injurious behavior using a water mist: initial response suppression and generalization. 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