The safety of functional analyses of self-injurious behavior.

Kahng et al. (2015) read 99 hospital charts. Each chart was for a child who had a full functional analysis of self-injury. The team counted every cut, bruise, or bite that happened during testing. They wanted to know how often kids got hurt and how bad it was.

The study only looked at records from one inpatient unit. All tests followed the same safety rules. Staff watched each child every second and stopped sessions at the first sign of real harm.

Injuries were rare and mild. Most kids left with no new marks. When harm did happen, it was usually a small scratch or red spot that faded in minutes. No child needed stitches, medicine, or extra medical care because of the test.

The paper shows that when staff use clear safety steps, functional analysis is a low-risk tool.

Frank-Crawford et al. (2024) looked at 200-plus newer studies and found that 70 percent now report safety steps such as padding, shorter sessions, or protective gloves. Their big-picture view supports the 2015 finding: injuries stay low when teams plan for safety.

Rooker et al. (2020) dug deeper. They linked each injury to the SIB’s function and saw that one subtype—automatic Subtype 2—caused the worst harm. This detail extends the 2015 paper. SungWoo told us "hurt is rare"; Rooker tells us "when hurt does happen, watch for this pattern."

Johnson et al. (2009) showed that safety gear can even help find the true function. They reran an analysis with helmets and arm guards and uncovered an attention function that the first test had missed. Taken together, these papers say: protect first, then use the data to refine your hypothesis.

You can run a full functional analysis without fearing major injury. Use the safeguards now common in the field: stay close, keep sessions brief, use padding, and stop early. Chart any marks that do occur; they may guide you to the right function and the right treatment.