The influence of therapist attention on self-injury during a tangible condition.

The team ran a functional analysis on a child who hurt himself. They wanted to see if extra eye contact and praise during the tangible test would change the results.

They compared two tangible sessions: one with no attention and one where the therapist gave brief praise every 30 seconds. The child’s self-injury was recorded in both.

When the therapist talked during the tangible condition, the child still hurt himself. Without that talk, the behavior dropped.

The extra attention made it look like the child wanted toys, not attention. The real reason—attention—was hidden.

Einfeld et al. (1995) showed the opposite: when they took attention away, breath-holding stopped. That study proved attention was the true payoff.

Horner-Johnson et al. (2002) now warn that if you give even tiny bits of attention during a tangible test, you can repeat the same mistake and miss an attention function.

Mead Jasperse et al. (2023) add another twist. They found that self-injury can stay high even without attention if the behavior helps the child get to another reward. Their work extends the warning: watch for hidden links, not just extra praise.

Before you call a behavior “tangible,” run one tangible session with zero eye contact, smiles, or praise. If the behavior fades, switch the plan and test an attention condition. This five-minute check can save weeks of wrong treatment.