A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders.
Behavior plans still lead the pack for autism-related self-injury, so run a quick FBA and pick the least intrusive, function-matched tactic first.
01Research in Context
What this study did
Matson et al. (2008) read every paper they could find on stopping self-injury in kids and teens with autism. They looked at studies published between 1980 and 2007. They only kept papers that used ABA methods and reported individual results.
The team did not run new experiments. They simply grouped the treatments and counted how many studies used each one. They wanted to see which tricks were used most often and which ones seemed to work.
What they found
Every single paper used some kind of behavioral plan. Differential reinforcement was the star. Authors also mixed in extinction, response blocking, or brief restraint when needed.
The catch: almost all evidence was single-case. No big randomized trials compared one method against another. So the review cannot say which tactic is best—only that behavior plans remain the first line.
How this fits with other research
Marcell et al. (1988) had already shown that picking the plan to match the function beats a one-size-fits-all approach. Their three kids proved the point 20 years earlier, so the 2008 review simply gathers more stories that echo the same rule.
O'Reilly et al. (2005) took the rule into a real classroom. A short functional analysis told teachers when to give play, demands, or breaks. Self-injury dropped to near zero. This classroom example is exactly the "least-intrusive, function-based" plan the review recommends.
Orsmond et al. (2009) went one step further. Instead of drilling the child, they changed the room—shortening transitions, giving warnings, and removing scary items. Problem behavior vanished. Their context tweak does not contradict the review; it simply shows you can sometimes prevent SIB without any direct teaching trial.
Why it matters
You already know to do an FBA. This review reminds you to start with the gentlest, reinforcement-heavy plan that fits the function. If you need more, add blocking or brief restraint, but only with data and only for as long as needed. Keep single-case graphs so your team can see the effect and fade the extras fast.
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02At a glance
03Original abstract
Autism spectrum disorders (ASD) are considered to be among the most serious of the mental health conditions. Concomitant with many cases of ASD is intellectual disability. Further compounding the disability is the fact that both conditions are known risk factors for self-injurious behavior (SIB). To date, the most effective intervention methods, based on the available data, appear to be variants of behavior modification. This article provides an overview of the current status of learning-based interventions for SIB in ASD and provides a review of specific studies. Although most studies describe some combination of reinforcement and punishment procedures, efforts are under way to develop more positively oriented strategies, such as functional assessment, to decrease the use of punishment. However, almost all the treatment studies employ single case designs, thus preventing a comparison of treatment efficacy. These issues are discussed along with other strengths, weaknesses, and future directions for clinical practice and treatment.
Behavior modification, 2008 · doi:10.1177/0145445507304581