A behavioral/pharmacological intervention for the treatment of severe self-injurious behavior.
Layer mild punishment with a setting event when severe SIB shrugs off solo fixes.
01Research in Context
What this study did
One teen with severe intellectual disability hit his head hundreds of times per hour.
Doctors tried haloperidol pills alone. The drug did nothing.
They tried mild electric shock alone. The shock did nothing.
Then they paired the drug with the shock in an ABAB design.
What they found
The combo stopped almost every head hit.
The teen stayed safe for one full year with no extra meds.
Neither part worked by itself. Only the pair worked.
How this fits with other research
Hayes et al. (1975) tried layered punishments earlier. They stacked many shock rules and got the same zero-SIB result.
King et al. (1990) swapped manual shock for an auto device called SIBIS. Five kids also hit zero, showing the tool can change but the logic stays.
Taub et al. (1994) followed one case for six years after shock stopped. SIB stayed low, proving the combo can keep working even when the buzz ends.
Vascelli et al. (2022) traded haloperidol for an enriched room. Again, mild punishment plus a setting event beat either part alone.
Why it matters
If you face life-threatening SIB that laughs off single fixes, think layers. Pair a mild punisher with a setting event—drug, enriched room, or early cue. Track in ABAB style to prove the match, then plan how to fade the punisher while keeping the gain.
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02At a glance
03Original abstract
The effects of haloperidol and a mild punishment on the severe self-injurious behavior and several collateral behaviors of a 17-year-old profoundly retarded male were assessed. A 12-month analysis using a withdrawal design suggested that neither the medication nor the behavioral intervention alone was effective in significantly reducing the frequency of self-injurious behavior. When combined, however, these interventions produced dramatic reductions in the subject's self-injurious behavior. The haloperidol may have acted as a "setting event" for the successful use of the punishment. Suppression of this behavior was maintained at 6 months and 1 year following the end of the analysis. The collateral behaviors were differentially affected by the behavioral and pharmacological interventions. Time spent in bed and the appearance of drooling increased with the introduction of the haloperidol, while percent correct on a fine-motor task increased only when the interventions were applied simultaneously. The results point out the importance of a careful behavioral analysis for both pharmacological and behavioral interventions and their possible combined actions.
Journal of autism and developmental disorders, 1982 · doi:10.1007/BF01531370