The establishing effects of client location on self-injurious behavior.
Simply moving a client out of a wheelchair dropped attention-maintained self-injury to near zero.
01Research in Context
What this study did
One adult who hurt himself lived in two spots: sitting in his wheelchair or on a regular chair.
Staff gave the same attention in both spots. The team counted how often he hit himself in each place.
What they found
He hit himself far more when he was in the wheelchair. Same room, same staff, same rules—only the seat changed.
The chair itself acted like a switch that made attention hurt more, so he fought harder to get it.
How this fits with other research
Symons et al. (2005) later saw the same idea in kids with Cornelia de Lange: odd triggers raised SIB, but each child had his own list.
O'Reilly (1996) had already shown that a night of respite care could set off next-day SIB; the 1997 paper swaps respite for a wheelchair and gets the same spike.
Rispoli et al. (2016) looked at the flip side—giving toys before class cut problem behavior for one hour. All three studies say the same plain thing: what happens right before the session can make or break behavior.
Why it matters
Check the chair, not just the plan. If SIB jumps in one spot, try moving the client, padding the seat, or teaching a break request while seated. A five-second swap can save hours of treatment later.
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02At a glance
03Original abstract
Three functional assessments were conducted with a client with self-injurious behavior (SIB), which indicated that SIB appeared to be sensitive to attention as reinforcement. In addition, levels of SIB were much higher when the client was seated in his wheelchair. An additional analysis was conducted in which client location (in and out of wheelchair) was altered while reinforcement contingencies (attention) for SIB were held constant. Levels of SIB again were higher when the client was positioned in his wheelchair, even though the consequences for SIB were identical. The results of this final analysis suggested that the wheelchair functioned as an establishing stimulus altering the efficacy of social positive reinforcement.
Research in developmental disabilities, 1997 · doi:10.1016/s0891-4222(97)00017-6