Evaluation of a Treatment Package for Chronic, Stereotypic Hand Mouthing of a Child Diagnosed with Autism

A clinic team worked with one young learners boy who had autism and kept putting his hand in his mouth. The behavior happened all day and had already caused skin sores. Staff first tried giving toys and attention for no hand-mouthing, but the behavior stayed high.

Next they added two things together. First, any time his hand touched his mouth they gently blocked it and told him to clap or put his hands on the table (response interruption and redirection, RIRD). Second, if he kept trying to mouth after the block, he had to wear a soft glove for one minute. They tracked hand-mouthing across 30-minute sessions every day for six weeks.

Hand-mouthing fell from about 25 times each half-hour to zero or one time within the first week. The glove was used only two or three times per day after the second week. No new sores appeared and old ones healed.

When staff later removed the glove rule for short test periods, the behavior stayed low. Parents learned the steps and saw the same near-zero levels at home during follow-up checks one and two months later.

Rayfield et al. (1982) first showed that making protective gear contingent on self-injury could cut the behavior and still let you fade the gear out. Thakore et al. (2024) now repeats that trick for hand-mouthing by pairing the glove with RIRD instead of the older differential-reinforcement-only package.

Luiselli (1989) used contingent gloves alone and got big drops in skin picking. The new study keeps the contingent glove idea but adds the RIRD block-and-replace step, giving a two-step package that works when reinforcement-only plans fail.

Neisworth et al. (1985) tried a quick extinction burst (CRF then sudden stop) and saw fast stereotypy drops, but only one of two people kept the gain. Adding the brief glove contingency in 2024 appears to give longer maintenance without extra booster sessions.

If you have a client whose automatic stereotypy keeps hurting them even after you reinforce other behaviors, try tacking on a short, contingent protective piece. You block the response, give a clear alternate action, and allow a mild consequence (one-minute glove) only if the behavior returns. You may see near-zero levels within days and still fade the equipment out, avoiding the need for bulky restraints or sedating meds.