Assessment and treatment of multiply maintained self injury for a visually impaired elementary student with autism

Snyder et al. (2024) worked with an elementary student who had autism and very limited vision. The child hit and bit himself many times each day.

First the team ran a full functional analysis. They found the self-injury was multiply maintained—sometimes it escaped hard tasks, sometimes it gained teacher attention, and sometimes it produced a nice sensory feeling.

Standard FCT worked once the team added non-visual pieces. They gave the boy a big red button that said 'break please' in a loud, clear voice when pressed.

Self-injury dropped to near zero after only a few sessions. The boy used the button on his own and no longer needed adult hand-over-hand help.

Jongsun et al. (2019) reviewed twelve FCT studies for students with autism. Every study cut self-injury, but most used picture cards or spoken words. Snyder shows the same plan still works when you swap in sound or touch for kids who cannot see.

Rivera et al. (2023) also used FCT with an elementary student, but their child had typical vision and the parents ran the sessions at home. Both papers found large drops in problem behavior, proving FCT works across settings and delivery agents.

Muharib et al. (2022) showed that adding small delays to reinforcement keeps FCT gains strong. Snyder followed the same delay rules, linking the single case to the larger meta-analytic pattern.

If you work with a learner who is blind or has low vision, do not rely on picture cards or hand signals. Give them a talking button, a textured card to squeeze, or any cue they can hear or feel. The response must be as easy as the self-injury, or the child will stick with the old way. One simple Monday move: place a single big-button voice output device on the desk and teach one clear message like 'I need help.'