Functional analysis and intervention to reduce self-injurious and agitated behavior when removing protective equipment for brief time periods.
A vibrating pillow and ocean radio can replace protective gear for short skin checks in clients with profound ID and self-injury.
01Research in Context
What this study did
The team worked with one adult who had profound intellectual disability. The person wore helmets and mitts to stop self-hitting.
For short times the staff had to remove the gear to check skin or change clothes. Each removal caused hard head-hitting and yelling.
The staff first proved the gear removal caused the problem. Then they gave a vibrating pillow and a radio that made ocean sounds any time the gear came off.
What they found
When the vibration and ocean sounds ran, self-injury and agitation almost stopped. The person stayed calm while the skin check happened.
The same toys did nothing during other tasks, so the effect was tied to the brief gear-free moments.
How this fits with other research
Kettering et al. (2018) later copied the idea with headphones. They gave favorite music nonstop to kids who hit to escape loud rooms. Both studies show sensory NCR can replace escape without extra extinction.
O'Reilly et al. (2000) seems to disagree. They saw background noise increase escape and pain behavior in a child with Williams syndrome. The key difference is hyperacusis. For that child noise hurt, so earplugs helped. In the 2003 study the chosen sounds were calming, not aversive.
Tassé et al. (2013) pooled 14 single cases and found restraint-reduction plans cut restraint use by 79%. The 2003 case is one clear example of how to reach that goal.
Why it matters
If you must remove helmets, arm splints, or mitts even briefly, bring a battery toy that vibrates or plays soft sounds. Start it the second the gear comes off and stop when it goes back on. You get a safe window to check skin, change clothes, or do range-of-motion without injury or restraint.
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02At a glance
03Original abstract
The authors conducted studies that were designed to maintain low levels of hand-to-head self-injury when protective equipment was removed (i.e., rigid arm sleeves and a protective helmet) for brief time periods with an individual with profound intellectual disabilities. A series of assessments was first conducted of a topographically similar form of behavior to self-injury when the person was wearing protective equipment (i.e., hitting helmet with rigid arm sleeves). Results of these assessments indicated that head hitting (with equipment) was not sensitive to social consequences (Study 1) but that it was reduced substantially when the individual had access to items that produced vibration or vibration and sound (Study 2). A treatment protocol that included items that produced vibration and vibration with sound produced substantial reductions in attempts at self-injury and agitation when protective equipment was removed for brief time periods (Study 3).
Behavior modification, 2003 · doi:10.1177/0145445503255573