Treatment of assaultive hair pulling in a multihandicapped youth.

A teenage boy with intellectual disability pulled out his own hair and hit anyone who tried to stop him.

Standard plans—rewards, restraint, time-out—had already failed.

The clinician broke a small ammonia capsule under the boy’s nose each time hair pulling began.

The pulling stopped after only a few ammonia trials.

Hair grew back and the youth stayed calm during follow-up.

No side effects were reported.

Rincover et al. (1975) did the same thing five years earlier on self-hitting in an adult with autism. Their data show ammonia works fast, but the behavior returns if staff stop using it.

Wallander et al. (1983) later used ammonia on severe aggression in a young child and saw extra gains—more play, less yelling—that lasted 14 months.

Sievers et al. (2020) looks like the opposite story: a gentle talk therapy (ACT) also cut hair pulling, but in teens and adults without intellectual disability. The two studies do not clash; they serve different people.

When you have tried every standard plan and the behavior is dangerous, ammonia remains an option. Use it only with medical sign-off, clear ethics approval, and a plan to fade it out. Document each trial so the team knows when to quit or keep going.