Treatment of self‐injurious behavior using differential punishment of high rates of behavior (DPH)

Manente and colleagues worked with one adult who had autism and bad self-hitting.

The team used DPH. That means they set a rule: no more than two hits in five minutes.

If the man went over the limit, staff gave a quick spray of water to his face. If he stayed under, nothing happened.

The hits almost stopped. The plan kept working for months with fewer staff around.

Water spray only came out when the rate got too high, so it was used less than normal punishment.

Luehring et al. (2026) got the same good result with kids, but they used rewards instead of punishment. Both papers show big drops in severe behavior, so you can pick either tool.

Shahan et al. (2021) saw the opposite: when they thinned rewards too fast, problem behavior came back. Their warning pairs well with DPH — one method stops the behavior, the other tells you how to keep it gone.

Singh et al. (1985) looked at drugs for self-injury and found thin proof. Manente’s 2017 case adds fresh evidence that a small, clear behavioral plan can beat pills.

You now have a low-effort option for dangerous self-hitting. Set a clear response limit, track rate, and deliver a mild punisher only when the limit is broken. Start with tight windows like five minutes, then stretch them. The plan saves staff time and keeps clients safe.