Assessment and treatment of chronic hand mouthing.
Start hand-mouthing treatment with simple free toys every 30 seconds; add gloves, blocking, or DRA only if needed.
01Research in Context
What this study did
The team worked with 14 adults who lived in a group home and had severe hand mouthing.
Each person got a five-step NCR plan. Step 1 gave a favorite item every 30 seconds no matter what.
If mouthing stayed high, they added thicker gloves, then response blocking, then DRA for toy play, and finally extra exercise. Staff moved to the next step only if the last one failed.
What they found
Thirteen people stopped or almost stopped mouthing by step 2. Only one person needed the full five-step package.
Mouthing stayed low for at least three months with almost no extra work.
How this fits with other research
Lippold et al. (2009) used a similar step-up plan for sleep problems in the same kind of homes. Both studies show you can start simple and add pieces only when needed.
Taylor et al. (2017) later pooled many ID studies and found big early gains often fade unless you add booster sessions. Capio et al. (2013) got durable results, probably because the NCR items stayed available forever.
Regnier et al. (2022) warn that any reward system needs a fade-out plan. The 2013 paper did not test formal thinning, so you may need one later.
Why it matters
You can copy the stepped NCR menu today. Start with free toys or music every 30 seconds. If mouthing drops 80 %, stop there. If not, add gloves or blocking one at a time. This saves effort and keeps the plan friendly. Write the step order on the data sheet so any staff knows when to escalate.
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02At a glance
03Original abstract
Hand mouthing (HM) is a chronic problem in many individuals with intellectual disabilities. Although the prevalence of mouthing has been estimated, data on the frequency, severity, or functions of the behavior were not included. In Study 1, we examined the prevalence and risk of HM. Results obtained from interviews showed that the prevalence of HM in two institutional samples (N = 802) was 12.7%, whereas direct observation yielded a lower estimate of prevalence (8%). Moreover, a large proportion of observed HM (39.1%) was self-injurious in nature. In Study 2, we used modified functional analyses (FAs) to examine the HM of 64 individuals. Results indicated that maintenance by automatic reinforcement accounted for 98.4% of the cases (all but one case). In Study 3, we implemented a progressive series of interventions for HM exhibited by 14 individuals. The following interventions were implemented in sequential order: (a) noncontingent reinforcement (NCR, effective with 6 subjects), (b) either NCR plus differential reinforcement of alternative behavior (DRA) plus response blocking (effective with 5 subjects) or NCR plus response blocking only (effective with 2 subjects), and (c) NCR plus brief manual restraint (effective with 1 subject).
Journal of applied behavior analysis, 2013 · doi:10.1002/jaba.14