Assessment and treatment of episodic self-injury: a case study.

One child hurt himself only on certain days. The team asked: what happens the night before?

They tracked respite care. When respite ended, self-injury spiked. They tested this link three times.

Then they changed the rule. Respite staff no longer removed attention when the child self-injured. The behavior stopped for good.

Respite care the night before acted like a switch. It set the stage for next-day self-injury.

Changing one detail—how staff reacted—erased the behavior. The child stayed safe for months.

Symons et al. (2005) looked at eight children with Cornelia de Lange. They also found odd triggers, like a loud hallway. Both studies say: test each child’s unique setting events.

Fabbretti et al. (1997) showed that sitting in a wheelchair raised self-injury even when staff gave the same attention. Like O'Reilly (1996), they proved the trigger can sit outside the usual session.

Tiger et al. (2021) tweaked standard functional analysis with prompts and blocking. O'Reilly (1996) did the same by probing the night before. Both papers push us to refine the test when the first pass is unclear.

If a client’s self-injury comes and goes, look past the therapy room. Ask parents, respite workers, bus drivers. Change one variable in that hidden context. You might stop the behavior without new punishers or rewards.