The treatment of severe self-injurious behavior by the systematic fading of restraints: effects on self-injury, self-restraint, adaptive behavior, and behavioral correlates of affect.
Gradually bending arm splints can end severe self-injury and get the gear off without making the client sad or needing other rewards.
01Research in Context
What this study did
Three adults with severe self-injury wore rigid arm splints 24 hours a day.
The team added a little bend to the splints each week instead of taking the splints off.
They watched self-hits, time in restraints, happy face movements, and play skills.
What they found
Two people stopped hitting themselves completely.
All three spent fewer hours in hard restraints.
No one looked more upset; play and smiles stayed the same.
How this fits with other research
Emmelkamp et al. (1986) did the first fade. They traded full arm tubes for light wristbands and also got zero self-injury. Gutierrez et al. (1998) kept the splints on but just made them softer—same win with even less risk.
Rosenthal et al. (1980) warned that any hard gear cuts social time. The 1998 fade kept social play steady, showing the bend-not-remove trick avoids that side effect.
Pilgrim et al. (2000) used quick electric aversion to cut restraint time. Their method worked but is rarely used today. Slow flexion fading gives a safer, modern path.
Why it matters
If a client still needs arm splints, ask the doctor to approve a tiny bend. Add five degrees every few days while you keep data. You may remove the injury and the restraints without extra rewards or punishment.
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02At a glance
03Original abstract
Severe self-injurious behavior (SIB) in people with mental retardation is difficult to treat when dangerously frequent or intense responding rules out functional analysis and interventions that permit free responding. This situation is common when restrictive devices, such as straight arm splints, are used. In this study, the effects of introducing flexion into a straight-arm splint, on SIB, self-restraint, adaptive behavior, and behavioral correlates of affect were examined for three individuals with severe mental retardation. Using single-case design methodology, for two individuals self-injury was reduced to zero, while the overall level of restriction was also significantly reduced. From the observed behavioral correlates of affect, there was no evidence of an increase in negative affect with the introduction of the new splint and the fading procedure, but there was evidence of an increase in positive vocalizations. Engagement in activities and social contact were not affected by the introduction of the new splint. The reasons for a decrease in SIB with a corresponding decrease in restriction in the absence of any manipulation of contingencies for SIB are discussed, with particular reference to stimulus control.
Research in developmental disabilities, 1998 · doi:10.1016/s0891-4222(97)00048-6