Using competing stimuli with an adult with stereotypic skin picking: A case study of assessment, treatment, and generalization
A quick competing-stimulus test plus free access to favorite items can stop adult skin picking and keep it gone for months.
01Research in Context
What this study did
Jeglum et al. (2022) worked with one adult who had autism and intellectual disability.
The man picked his skin so often it bled.
The team first ran a competing-stimulus assessment to find items he liked to touch.
They then gave those items for free every 30 seconds while teaching staff and parents to block picking and praise other hand use.
Follow-up checks ran for five months.
What they found
Skin picking dropped to almost zero during sessions and stayed there.
The man still kept his hands busy with the chosen items five months later when caregivers ran the plan.
How this fits with other research
Thomas et al. (2023) later used the same idea—parent-delivered competing items—for a teen who ate inedible objects.
They added response cost and kept the gains for a full year, showing the plan can travel across ages and topographies.
Matson et al. (1999) saw mixed results when they tried NCR alone for cigarette pica; the effect faded when they thinned the schedule.
Jeglum’s case avoided that fade-up by keeping dense free access and using response blocking, hinting that schedule thinning may need extra steps for some clients.
van Schrojenstein Lantman-de Valk et al. (2006) showed habit reversal also cuts adult skin picking, but Jeglum’s NCR route is easier for caregivers who struggle with the awareness piece.
Why it matters
If you serve adults who hurt their skin, run a quick competing-stimulus assessment first.
Pick two or three sensory items the client already reaches for.
Deliver them non-contingently, block picking, and praise neutral hand play.
Train staff and family to do the same.
The plan is simple, needs no talk-based components, and can keep gains for months.
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02At a glance
03Original abstract
AbstractThe competing stimulus assessment (CSA) is used to identify stimuli that are associated with high levels of engagement and low levels of problem behavior. However, few studies have used CSA results for adults with problem behavior. The goal of this study was to expand on previous literature by targeting an adult's self‐injurious skin picking, while incorporating caregivers into treatment and examining reduction maintenance. Noelle was a 27‐year‐old female diagnosed with autism spectrum disorder and intellectual disability referred to an intensive outpatient clinic. Functional assessment results suggested that skin picking was maintained by automatic reinforcement. Treatment included noncontingent access to competing stimuli identified via a CSA with response disruption and response promotion tactics. This intervention reduced skin picking to near zero rates, was effectively implemented by caregivers, and treatment gains were maintained over 5 months. Limitations and future considerations for behavior reduction procedures with adults are discussed.
Behavioral Interventions, 2022 · doi:10.1002/bin.1870