Treatment of hand mouthing in individuals with severe to profound developmental disabilities: a review of the literature.
Hand mouthing in severe ID is usually automatically reinforced—start with sensory-based antecedent strategies and reinforcement before considering response blocking.
01Research in Context
What this study did
The authors read every paper from 1995 to 2004 that tried to stop hand mouthing in teens and adults with severe or profound intellectual disability.
They found 23 studies and grouped the treatments into three buckets: things you give (toys, vibration, food), things you take away (response blocking, mitts, restraint), and mixes of both.
What they found
All 23 studies reported less hand mouthing after treatment.
Most behavior was driven by the feel of the mouth itself, not attention or escape.
The newer papers favored soft sensory items and rich reinforcement; older ones leaned on arm boards, helmets, or brief holds.
How this fits with other research
Rapport et al. (1996) is inside this review. Their brief hold plus a leisure item worked in a group home and still looked good eight years later.
Irvin et al. (1998) is also inside. Arm restraints cut mouthing but also cut other arm use, showing why the review later pushed kinder options.
Thakore et al. (2024) came 18 years after the review. They paired response interruption with contingent mitts and removed the need for any restraint, proving the review’s hunch that lighter packages could win.
Why it matters
Start with a sensory substitute the client already likes—vibrating toy, chewy tube, music. Add brief response blocking only if mouthing keeps returning. Track whether the replacement item also supports other hand skills so you do not trade one problem for another.
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Join Free →Place three sensory items the client will approach in a small bin near the work desk; deliver one before each session starts and record if hand mouthing drops during the first ten minutes.
02At a glance
03Original abstract
This paper reviews studies investigating the assessment and treatment of hand mouthing in individuals with severe to profound developmental disabilities. A literature search identified 101 studies carried out between 1969 and 2004. The trend in the studies indicated a shift away from aversive interventions in the last 10 years, so this review included studies conducted from 1995. Twenty-three studies were identified within this period and were included in this review. The 23 studies were sorted into seven intervention categories and one assessment category. The seven intervention categories included (a) antecedent interventions, (b) multicomponent interventions (e.g., differential reinforcement and response effort), (c) pharmacological interventions, (d) interventions that utilized reinforcement, (e) response blocking interventions, (f) response effort interventions, and (g) sensory stimulation interventions. The one assessment category included studies that investigated the function of hand mouthing. One main finding in these studies was that the various intervention strategies led to decreases in hand mouthing in individuals with severe to profound developmental disabilities. This finding is discussed in relation to its effect on issues of health, adaptive behavior, and social functioning. A second finding indicated that hand mouthing is often maintained by automatic reinforcement (i.e., non-social contingencies). The implications of this finding are discussed in terms of how assessments and treatments associated with automatically maintained challenging behavior might be more effectively linked. Potential issues for future research are also examined.
Research in developmental disabilities, 2006 · doi:10.1016/j.ridd.2005.06.004