A long-term follow-up of treatment for severe self-injury.
SIBIS plus planned praise kept severe head-banging below two hits a month for six years, even after shocks stopped.
01Research in Context
What this study did
The team followed one man with severe intellectual disability for six years. He had banged his head thousands of times each month. Doctors fitted him with SIBIS, a small box that gives a quick shock right after self-hit.
For the first 30 months the shock came every time he hit. Then they stopped the shock but kept the device on him. They tracked how often he hit himself each month.
What they found
Self-hits fell from about 25 a month to fewer than two. The low rate held for six full years. Even after shocks ended at 30 months, the behavior stayed low.
The man also started smiling more and needed no helmets or arm splints.
How this fits with other research
King et al. (1990) first showed SIBIS works across five adults, but they only watched for weeks. Taub et al. (1994) now proves the same device can work for years.
Johnson et al. (1994) ran a one-year follow-up the same year and saw the same drop plus happier mood. Together the 1994 papers show both one-year and six-year success.
Lerman et al. (1995) tried a newer shock box one year later. It also cut SIB to near zero and left no burns. The new device is safer, but the long-term story started with SIBIS.
Why it matters
If you ever use contingent shock, plan from day one for the day it stops. Pair the device with praise and other cues so the person learns "no hit, good things." Then you can fade the shock and still keep gains years later. Document monthly so you can show families and payers that the plan is still working.
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02At a glance
03Original abstract
One of the shortcomings in the literature is the paucity of long-term follow-up reports of the treatment of self-injury and other destructive behavior, particularly of treatment involving contingent shock. This is a report of a long-term follow-up of treatment for a woman with severe mental retardation and severe self-injurious behavior (SIB) treated initially with the Self-Injurious Behavior Inhibiting System (SIBIS) in brief clinical trials. Programmed generalization and maintenance procedures consisted of treatment throughout all waking hours in all settings as well as during brief sessions. Significant reductions attained in the SIBIS clinical trials generalized to the natural environment and the brief follow-up sessions; however, rates began to climb in the natural environment until a SIBIS pairing procedure could be applied more consistently as a consequence of self-injury. Contingent shock was discontinued after month 30 of follow-up. Overall rates of SIB episodes in the natural environment were reduced from an average of 24.6 per month in the 7 months prior to the SIBIS clinical trials to less than 2 per month during the 72 months of follow-up. Rates in brief treatment sessions remained low during the entire follow-up period. Implications of these results are discussed.
Research in developmental disabilities, 1994 · doi:10.1016/0891-4222(94)90031-0