Sensory-integrated habit reversal intervention for hair pulling and classroom engagement in children with autism: A multiple-baseline pilot study.
Adding quick sensory breaks to habit reversal let school staff wipe out hair pulling for eight autistic students while class stayed on track.
01Research in Context
What this study did
Eight autistic students who pulled their hair during class lessons joined the study.
Teachers learned a new package called sensory-integrated habit reversal, or SI-HR.
The package added quick sensory breaks, fidgets, or weighted items to the classic habit-reversal steps: notice the urge, use a competing action, and get praise.
What they found
Hair pulling dropped sharply for every child right after SI-HR started.
Low levels held for the rest of the school year.
Classroom engagement went up for most kids, but the gain was smaller and less steady.
How this fits with other research
Richman et al. (2001) ended hair twirling with bedtime mittens alone. Their child needed no school plan, but the behavior only happened at night. The new study shows that when the behavior occurs in class, you need a classroom-friendly tool like SI-HR.
Halbur et al. (2022) used a DRO schedule to stop face-touching in three autistic kids. Both papers used a multiple-baseline design and got big drops in body-focused behavior. SI-HR extends the toolkit by adding sensory regulation, useful when the behavior seems to feed off classroom noise or movement.
Hartz et al. (2020) cut spitting with differential reinforcement plus brief time-out. Like the hair-pulling study, they worked in class and saw large, lasting change. SI-HR offers an alternative that skips time-out and instead gives sensory input, a plus when staff prefer positive-only plans.
Why it matters
You now have a ready script for staff who say, "We tried ignoring and it didn’t work." Pair the old habit-reversal steps with the child’s favorite sensory tool—maybe a squeeze ball or five chair push-ups—and you can see the same fast drop in hair pulling while class keeps running. Try it next week during the hardest subject block; collect five-minute hair-pull counts before and after to see if it works for your kid.
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02At a glance
03Original abstract
BACKGROUND: Hair pulling is a body-focused repetitive behavior frequently observed in individuals with autism and is increasingly conceptualized as a developmentally mediated self-regulatory behavior that may interfere with adaptive participation across everyday contexts. Although habit reversal training (HRT) has demonstrated efficacy for reducing repetitive behaviors, evidence supporting its implementation in naturalistic settings, particularly when integrated with sensory-regulation supports remains limited. METHODS: This study examined the effects of a sensory-integrated habit reversal (SI-HR) intervention on hair pulling and functional engagement in autistic children within a naturalistic educational context. A multiple-baseline across participants single-case experimental design was employed with eight autistic students (four boys, four girls) aged 8-14 years. Following staggered baseline phases, trained school personnel implemented a manualized intervention combining core HRT components (awareness training, competing responses, and stimulus control) with individualized sensory-regulation strategies embedded within daily routines. Hair pulling was measured using partial-interval recording, and engagement was assessed using momentary time sampling as an indicator of attentional regulation and adaptive participation. Treatment fidelity, interobserver agreement, and social validity were evaluated. RESULTS: Visual analysis and nonoverlap indices demonstrated consistent and immediate reductions in hair pulling across participants, with large effects (NAP range = 0.92-1.00) and maintenance of gains during a maintenance/probe phase. Functional engagement increased for most participants, although the magnitude of change varied. Teachers and caregivers rated the intervention as feasible and acceptable under typical educational conditions. CONCLUSIONS AND RECOMMENDATIONS: Findings provide preliminary support for a sensory-integrated behavioral approach to reducing body-focused repetitive behavior in autistic children, with associated improvements in functional engagement. These findings should be interpreted cautiously given the multicomponent nature of the intervention and the small sample size, underscoring the need for replication, component analyses, and extended follow-up across developmental and rehabilitative contexts.
Research in developmental disabilities, 2026 · doi:10.1016/j.ridd.2026.105229