Decreasing self‐injury in a child with multiple disabilities: A practitioner's demonstration
One simple body movement can replace violent self-hits in children with many disabilities.
01Research in Context
What this study did
A preschooler with blindness, deafness, and limited movement hit her head hundreds of times a day.
The practitioner first watched when the hits happened. She learned the child wanted toys and people.
Next she taught one simple body movement the child could already do—lifting a knee. That knee lift became the new way to ask.
What they found
Self-hitting dropped to near zero once the child could lift her knee for toys or attention.
She started to move around and play on her own more often.
The new communication worked for weeks with no extra prompts.
How this fits with other research
Blair et al. (2025) pooled 34 kids and saw the same big drop in problem behavior when FCT is used in real-life places.
Tsami et al. (2020) saw most children lose gains when one piece of the plan was removed. The present child kept her progress even with fewer cues, likely because her plan stayed fully in place.
Bell (1999) used talking devices for school-age children. This case shows you can skip the device and still win if you pick a movement the child can already do.
Neely et al. (2018) warned that most FCT studies do not check long-term change. This single case adds one clear example where the fix held.
Why it matters
You now have proof that FCT works even when vision, hearing, and movement are all limited. Pick any small, reliable action the child already has—head turn, finger twitch, knee lift—and build the request around that. Keep the same toys and people in place so the new response keeps paying off. If you do, severe self-injury can drop to zero and stay there while the child gains play and independence.
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02At a glance
03Original abstract
AbstractSelf‐injurious behavior is thought to be the product of interactions between deficits related to a primary disability (e.g., limited communication repertoires and adaptive skills) and learning experiences that reinforce problem behavior (e.g., consoling the child, terminating non‐preferred activities, etc.). For these cases, functional communication training (FCT) may be prescribed to decrease challenging behavior and increase the client's communicative repertoire. However, FCT procedures for individuals with multiple physical impairments may require considerable individualization and modifications. Unfortunately, the existing body of research related to the assessment and treatment of behavior of individuals with motor, visual, or other impairments is relatively limited. The purpose of this report is to demonstrate how practitioners can modify assessment and treatment procedures to decrease challenging behavior and promote independence when working with individuals with multiple impairments. We provide an example of effective skill acquisition and behavior reduction interventions for a young girl, Ava, presenting with multiple disabilities—including visual, hearing, and motor impairments. Consistent with the habilitative aims of applied behavior analysis, the intervention was effective at decreasing Ava's challenging behavior and increasing her independent communication and adaptive behavior.
Behavioral Interventions, 2024 · doi:10.1002/bin.2058