Functional analysis of self-injurious behavior in an adult with Lesch-Nyhan syndrome.

Carr et al. (2002) ran a three-phase functional analysis on an adult with Lesch-Nyhan syndrome.

The team compared attention, alone, and demand conditions while blocking every head-hit.

They scored tiny arm-raises and facial grimaces as precursors instead of the blocked self-injury.

Precursors only surged when staff gave brief comments after each one.

Social attention worked like a green light: its presence set off the chain that leads to self-injury.

No treatment was tested; the analysis stopped after the function was clear.

Hoch et al. (1994) surveyed many Lesch-Nyhan cases and warned that classic behavior plans rarely help.

That survey paints the same picture: stress and attention matter more than classic reinforcement.

Lovaas et al. (1969) first showed that turning attention on and off can control self-injury in children with ID.

E et al. extend that old finding to an adult with a rare genetic syndrome by measuring precursors.

Levin et al. (2014) found automatic reinforcement for skin-picking in Prader-Willi, unlike the social function seen here.

The difference is topography and syndrome, not method—both studies used solid functional analyses.

If you must block severe self-injury for safety, you can still get a clean functional analysis by scoring the tiny moves that come right before.

When attention is the trigger, plan to give it on a schedule or teach a simple request instead of reacting only after the fact.