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Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature

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Abstract

Our purpose in this systematic review was to identify, evaluate, and summarize the single-case research design studies examining behavioral interventions to address self-injurious behavior for young children with autism spectrum disorder. We identified 24 studies published between 2000 and 2016 that met the inclusion criteria. We reviewed and coded each study across five content areas using systematic procedures. These content areas consisted of the methodological quality of single-case research designs, children’s demographic information, conditions under which the intervention was implemented, characteristics of intervention, and outcomes. Our findings indicate that procedural integrity data were reported for only one study and social validity for two studies. The majority of studies were implemented by researchers or therapists in the school setting. For 24 of 30 children included in the studies reviewed, the authors taught a replacement behavior selected on the basis of an assessment conducted prior to intervention. All authors reported a decrease in the self-injurious behavior post-intervention. A limited number of authors examined generalization and maintenance of low rates of self-injurious behavior. Limitations of the present review and future directions and implications for research and practice are discussed.

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References

  • *Indicates study included in the review

  • Baghdadli, A., Pascal, C., Grisi, S., & Aussilloux, C. (2003). Risk factors for self-injurious behaviors among 222 young children with autistic disorders. Journal of Intellectual Disabilities Research, 47, 622–627. doi:10.1046/j.1365-2788.2003.00507.x.

    Article  Google Scholar 

  • Barrera, F. J., Violo, R. A., & Graver, E. E. (2007). On the form and function of severe-injurious behavior. Behavioral Interventions, 22, 5–33. doi:10.1002/bin.228.

    Article  Google Scholar 

  • Barretto, A., Wacker, D. P., Harding, J., Lee, J., & Berg, W. (2009). Using telemedicine to conduct behavioral assessments. Journal of Applied Behavior Analysis, 39, 333–340. doi:10.1901/jaba.2006.173-04.

    Article  Google Scholar 

  • Carr, E. G., Horner, R. H., Turnbull, A. P., Marquis, J. G., Magito-McLaughlin, D., McAtee, M. L., et al. (1999). Positive behavior support for people with developmental disabilities: A research synthesis. Washington, DC: American Association on Mental Retardation Monograph Series.

    Google Scholar 

  • Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., & Smith, C. E. (1997). Communication-based interventions for problem behavior: A user’s guide for producing positive behavior change. Baltimore, MD: Paul H. Brookes Publishing.

    Google Scholar 

  • *Carter, S. L., & Wheeler, J. J. (2007). Analysis of behavioural responding across multiple instructional conditions for a child with childhood integrative disorder. Journal of Research in Special Education Needs, 7, 137–141. doi:10.1111/j.1471-3802.2007.00090.x.

    Article  Google Scholar 

  • *Casey, S. D., & Merical, C. L. (2006). The use of functional communication training without additional treatment procedures in an inclusive school setting. Behavioral Disorders, 32, 46–54.

    Google Scholar 

  • Chezan, L. C., Kratochwill, T. R., Terjesen, M., & Nguyen, K. V. (2017). Measuring outcomes in the schools. In M. Thielking & M. Terjesen (Eds.), Handbook of Australian School Psychology: International research, practice and policy (pp. 663–689). New York, NY: Springer. doi:10.1007/978-3-319-45166-4_35.

    Chapter  Google Scholar 

  • *Christensen, T. I., Ringdahl, J. E., Bosch, J. J., Falcomata, T. S., Luke, J. R., & Andelman, M. S. (2009). Constipation associated with self-injurious and aggressive behavior exhibited by a child diagnosed with autism. Education and Treatment of Children, 32, 89–103.

    Article  Google Scholar 

  • Conroy, M. A., Dunlap, G., Clarke, S., & Alter, P. J. (2005). A descriptive analysis of positive behavioral intervention research with young children with challenging behavior. Analysis of Positive Behavioral Intervention Research, 25, 157–166. doi:10.1177/02711214050250030301.

    Google Scholar 

  • Cook, B. G., & Odom, S. L. (2013). Evidence-based practices and implementation science in special education. Exceptional Children, 79, 135–144. doi:10.1177/001440291307900201.

    Article  Google Scholar 

  • *Cornelius Habarad, S. M. (2015). The power of the mand: Utilizing the mand repertoire to decrease problem behavior. Behavioral Development Bulletin, 20, 158–162. doi:10.1037/h0101310.

    Article  Google Scholar 

  • Dawson, J. E., Matson, J. L., & Cherry, K. E. (1998). An analysis of maladaptive behaviors in persons with autism, PDD-NOS, and mental retardation. Research in Developmental Disabilities, 19, 439–448. doi:10.1016/S0891-4222(98)00016-X.

    Article  PubMed  Google Scholar 

  • *DeLeon, I. G., Fisher, W. W., & Marhefka, J. M. (2004). Decreasing self-injurious behavior associated with awakening in a child with autism and developmental delays. Behavioral Interventions, 19, 111–119. doi:10.1002/bin.154.

    Article  Google Scholar 

  • *Demanche, J., & Chok, J. T. (2013). The use of wrist weights and vibratory stimulation to treat self-injurious behavior. Journal of Developmental and Physical Disabilities, 25, 79–90. doi:10.1007/s10882-012-9304-2.

    Article  Google Scholar 

  • *DeRosa, N. M., Roane, H. S., Doyle, N. M., & McCarthy, C. A. (2013). Modification of response cost hierarchies through differential reinforcement of functionally equivalent communication. Journal of Developmental and Physical Disabilities, 25, 119–133. doi:10.1007/s10882-012-9312-2.

    Article  Google Scholar 

  • *Devlin, S., Healy, O., Leader, G., & Hughes, B. (2011). Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior. Journal of Autism and Developmental Disorders, 41, 1303–1320. doi:10.1007/s10803-010-1149-x.

    Article  PubMed  Google Scholar 

  • Doehring, P., Reichow, B., Palka, T., Phillips, C., & Hagopian, L. (2014). Behavioral approaches to managing severe problem behaviors in children with autism spectrum disorder and related developmental disorders: A descriptive analysis. Child and Adolescent Psychiatric Clinics of North America, 23, 25–40. doi:10.1016/j.chc.2013.08.001.

    Article  PubMed  Google Scholar 

  • Durand, V. M., & Merges, E. (2001). Functional communication training: A contemporary behavior analytic intervention for problem behaviors. Focus on Autism and Other Developmental Disabilities, 16, 110–119. doi:10.1177/108835760101600207.

    Article  Google Scholar 

  • *Falcomata, T. S., Roane, H. S., Muething, C. S., Stephenson, K. M., & Ing, A. D. (2012). Functional communication training and chained schedules of reinforcement to treat challenging behavior maintained by terminations of activity interruptions. Behavior Modification, 36, 630–649. doi:10.1177/0145445511433821.

    Article  PubMed  Google Scholar 

  • Fisher, W. W., Kuhn, D. E., & Thompson, R. H. (1998). Establishing discriminative control of responding using functional and alternative reinforcers during functional communication training. Journal of Applied Behavior Analysis, 31, 543–560. doi:10.1901/jaba.1998.31-543.

    Article  PubMed  PubMed Central  Google Scholar 

  • Foxx, R. M. (2013). The maintenance of behavioral change: The case for long-term follow-ups. American Psychologist, 68, 728–736. doi:10.1037/a0033713.

    Article  PubMed  Google Scholar 

  • *Foxx, R. M., & Garito, J. (2007). The long term successful treatment of the very severe behaviors of a preadolescent with autism. Behavioral Interventions, 22, 69–82. doi:10.1002/bin.232.

    Article  Google Scholar 

  • Gast, D. L. (Ed.). (2010). Single-subject research methodology in behavioral sciences. New York, NY: Routledge.

    Google Scholar 

  • *Hagopian, L. P., Wilson, D. M., & Wilder, D. A. (2001). Assessment and treatment of problem behavior maintained by escape from attention and access to tangible items. Journal of Applied Behavior Analysis, 34, 229–232. doi:10.1901/jaba.2001.34-229.

    Article  PubMed  PubMed Central  Google Scholar 

  • *Hausman, N., Kahng, S. W., Farrell, E., & Mongeon, C. (2009). Idiosyncratic functions: Severe problem behavior maintained by access to ritualistic behaviors. Education and Treatment of Children, 32, 77–87.

    Article  Google Scholar 

  • *Heffernan, L., & Lyons, D. (2016). Differential reinforcement of other behaviour for the reduction of severe nail biting. Behavior Analysis in Practice. doi:10.1007/s40617-016-0106-3.

    PubMed  PubMed Central  Google Scholar 

  • Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the country of Hedmark, Norway: Prevalence, and risk markers. Research in Developmental Disabilities, 27, 456–465. doi:10.1016/j.ridd.2005.06.001.

    Article  PubMed  Google Scholar 

  • Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practices in special education. Exceptional Children, 71, 165–179. doi:10.1177/001440290507100203.

    Article  Google Scholar 

  • Horner, R. H., Carr, E. G., Strain, P. S., Todd, A. W., & Reed, H. K. (2002). Problem behavior interventions for young children with autism: A research synthesis. Journal of Autism and Developmental Disorders, 32, 423–446. doi:10.1023/A:1020593922901.

    Article  PubMed  Google Scholar 

  • Iwata, B. A., Pace, G. M., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1982/1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197–209. doi:10.1901/jaba.1994.27-197.

  • Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York, NY: Oxford University Press.

    Google Scholar 

  • Kennedy, C. H. (2002). The maintenance of behavior change as an indicator of social validity. Behavior Modification, 26, 594–604. doi:10.1177/014544502236652.

    Article  PubMed  Google Scholar 

  • Kratochwill, T. R., Hitchcock, J. H., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., et al. (2013). Single-case intervention research design standards. Remedial and Special Education, 34, 26–38. doi:10.1177/0741932512452794.

    Article  Google Scholar 

  • La Malfa, G., Lassi, S., Salvini, R., Giganti, C., Bertelli, M., & Albertini, G. (2007). The relationship between autism and psychiatric disorders in intellectually disabled adults. Research in Developmental Disabilities, 1, 218–228. doi:10.1016/j.rasd.2006.10.004.

    Google Scholar 

  • *Ladd, M. V., Luiselli, J. K., & Baker, L. (2009). Continuous access to competing stimulation as intervention for self-injurious skin picking in a child with autism. Child & Family Behavior Therapy, 31, 54–60. doi:10.1080/07317100802701400.

    Article  Google Scholar 

  • LaRue, R. H., Lenard, K., Weiss, M. J., Bamond, M., Palmieri, M., & Kelley, M. E. (2010). Comparison of traditional and trial-based methodologies for conducting functional analyses. Research in Developmental Disabilities, 31, 480–487. doi:10.1016/j.ridd.2009.10.020.

    Article  PubMed  Google Scholar 

  • *Luiselli, J. K., Cochran, M. L., & Huber, S. A. (2005). Effects of otitis media on a child with autism receiving behavioral intervention for self-injury. Child & Family Behavior Therapy, 27, 51–56. doi:10.1300/J019v27n02_05.

    Article  Google Scholar 

  • Machalicek, W., O’Reilly, M. F., Beretvas, N., Sigafoos, J., & Lancioni, G. E. (2007). A review of interventions to reduce challenging behavior in school settings for students with autism spectrum disorders. Research in Autism Spectrum Disorders, 1, 229–246. doi:10.1016/j.rasd.2006.10.005.

    Article  Google Scholar 

  • *Machalicek, W., O’Reilly, M., Chan, M. J., Lang, R., Rispoli, M., Davis, T., et al. (2009). Using videoconferencing to conduct functional analysis of challenging behavior and develop classroom behavioral support plans for students with autism. Education and Training in Developmental Disabilities, 44, 207–217.

    Google Scholar 

  • Machalicek, W., O’Reilly, M. F., Rispoli, M., Davis, T., Lang, R., Franco, J. H., et al. (2010). Training teachers to assess the challenging behaviors of students with autism using video tele-conferencing. Education and Training in Autism and Developmental Disabilities, 45, 203–215.

    Google Scholar 

  • *Magnusson, A. F., & Gould, D. D. (2007). Reduction of automatically-maintained self-injury using contingent equipment removal. Behavioral Interventions, 22, 57–68. doi:10.1002/bin.231.

    Article  Google Scholar 

  • Matson, J. L., & LoVullo, S. V. (2008). A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders. Behavior Modification, 32, 61–76. doi:10.1177/0145445507304581.

    Article  PubMed  Google Scholar 

  • Meyer, L. H., Peck, C. A., & Brown, L. (Eds.). (1991). Critical issues in the lives of people with severe disabilities. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Murphy, G., Beadle-Brown, J., Wing, L., Gould, J., Shah, A., & Homes, N. (2005). Chronicity of challenging behaviors in people with severe intellectual disabilities and/or autism: A total population sample. Journal of Autism and Developmental Disorders, 35, 405–418. doi:10.1007/s10803-005-5030-2.

    Article  PubMed  Google Scholar 

  • *Neidert, P. L., Iwata, B. A., & Dozier, C. L. (2005). Treatment of multiply controlled problem behavior with procedural variations of differential reinforcement. Exceptionality, 13, 45–53. doi:10.1207/s15327035ex1301_6.

    Article  Google Scholar 

  • *O’Reilly, M., Sigafoos, J., Lancioni, G., Edrisinha, C., & Andrews, A. (2005). An examination of the effects of a classroom activity schedule on levels of self-injury and engagement for a child with severe autism. Journal of Autism and Developmental Disorders, 35, 305–311. doi:10.1007/s10803-005-3294-1.

    Article  PubMed  Google Scholar 

  • Oliver, C., & Richards, C. (2015). Practitioner review: Self-injurious behaviour in children with developmental delay. Journal of Child Psychology and Psychiatry, 56, 1042–1054. doi:10.1111/jcpp.12425.

    Article  PubMed  Google Scholar 

  • *Padilla Dalmau, Y. C., Wacker, D. P., Harding, J. W., Berg, W. K., Schieltz, K. M., Lee, J. F., et al. (2011). A preliminary evaluation of functional communication training effectiveness and language preference when Spanish and English are manipulated. Journal of Behavior Education, 20, 233–251. doi:10.1007/s10864-011-9131-z.

    Article  Google Scholar 

  • Pelios, L., Morren, J., Tesch, D., & Axelrod, S. (1999). The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior. Journal of Applied Behavior Analysis, 32, 185–195. doi:10.1901/jaba.1999.32-185.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reid, D. H., & Parsons, M. B. (2002). Working with staff to overcome challenging behavior among people who have severe disabilities: A guide for getting support plans carried out. Morganton: Habilitative Management Consultants.

    Google Scholar 

  • Richards, C., Oliver, C., Nelson, L., & Moss, J. (2011). Self-injurious behavior in individuals with autism spectrum disorder and intellectual disability. Journal of Intellectual Disability Research, 56, 476–489. doi:10.1111/j.1365-2788.2012.01537.x.

    Article  Google Scholar 

  • Rojahn, J., Schroeder, S. R., & Hoch, T. A. (2007). Self-injurious behavior in intellectual disabilities. New York: Elsevier.

    Google Scholar 

  • *Schieltz, K. M., Wacker, D. P., Harding, J. W., Berg, W., Lee, J. F., Padilla Dalmau, Y. C., et al. (2011). Indirect effects of functional communication training on non-targeted disruptive behavior. Journal of Behavior Education, 20, 15–32. doi:10.1007/s10864-011-9119-8.

    Article  Google Scholar 

  • Sigafoos, J. (2000). Communication development and aberrant behavior in children with developmental disabilities. Education and Training in Mental Retardation & Developmental Disabilities, 35, 168–176.

    Google Scholar 

  • *Sigafoos, J., O’Reilly, M., Hui Ma, C., Edrisinha, C., Cannella, H., & Lancioni, G. E. (2006). Effects of embedded instruction versus discrete-trial training on self-injury, correct responding, and mood in a child with autism. Journal of Intellectual and Developmental Disability, 31, 196–203. doi:10.1080/13668250600999160.

    Article  PubMed  Google Scholar 

  • Snyder, P. A., Rakap, S., Hemmeter, M. L., McLaughlin, T. W., Sandall, S., & McLean, M. (2015). Naturalistic instructional approaches in early learning: A systematic review. Journal of Early Intervention, 37, 69–97. doi:10.1177/1053815115595461.

    Article  Google Scholar 

  • Stockard, J., & Wood, T. W. (2016). The threshold and inclusive approaches to determining “best available evidence”: An empirical analysis. American Journal of Evaluation. doi:10.1177/1098214016662338.

    Google Scholar 

  • Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349–367. doi:10.1901/jaba.1977.10-349.

    Article  PubMed  PubMed Central  Google Scholar 

  • Suess, A. N., Romani, P. W., Wacker, D. P., Dyson, S. M., Kuhle, J. L., Lee, J. F., et al. (2014). Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via Telehealth. Journal of Behavioral Education, 23, 34–59. doi:10.1007/s10864-013-9183-3.

    Article  Google Scholar 

  • Taylor, L., Oliver, C., & Murphy, G. (2011). The chronicity of self-injurious behaviour: A long-term follow-up of a total population study. Journal of Applied Research in Intellectual Disabilities, 24, 105–117. doi:10.1111/j.1468-3148.2010.00579.x.

    Article  Google Scholar 

  • *Toussaint, K. A., & Tiger, J. H. (2012). Reducing covert self-injurious behavior maintained by automatic reinforcement through a variable momentary DRO procedure. Journal of Applied Behavior Analysis, 45, 179–184. doi:10.1901/jaba.2012.45-179.

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Camp, C. M., Lerman, D. C., & Kelly, M. E. (2001). A method for analyzing changes in response efficiency. Journal of Applied Behavior Analysis, 34, 487–490. doi:10.1901/jaba.2001.34-487.

    Article  PubMed  PubMed Central  Google Scholar 

  • *Wacker, D. P., Harding, J. W., Berg, W. K., Lee, J. F., Schieltz, K. M., Padilla, Y. C., et al. (2011). An evaluation of persistence of treatment effects during long-term treatment of destructive behavior. Journal of the Experimental Analysis of Behavior, 96, 261–282. doi:10.1901/jeab.2011.96-261.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopleman, T. G., Lindgreen, S. D., Kuhle, J., et al. (2013). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46, 31–46. doi:10.1002/jaba.29.

    Article  PubMed  PubMed Central  Google Scholar 

  • Webster-Stratton, C. (1997). Early intervention for families of pre-school children with conduct problems. In M. J. Guralnick (Ed.), The effectiveness of early intervention (pp. 429–454). Baltimore, MD: Brookes.

    Google Scholar 

  • Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., et al. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45, 1951–1966. doi:10.1007/s10803-014-2351-z.

    Article  PubMed  Google Scholar 

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Chezan, L.C., Gable, R.A., McWhorter, G.Z. et al. Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature. J Behav Educ 26, 293–329 (2017). https://doi.org/10.1007/s10864-017-9269-4

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