By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Parent Training to Address Early Self-Injury in Young Children with Developmental Delays

Overview & Clinical Significance

Self-injurious behavior (SIB) in young children with intellectual and developmental disabilities represents one of the most urgent clinical challenges in applied behavior analysis. This course examines research by Fodstad, Kirsch, Faidley, and Bauer (2018) on parent training approaches to address early-onset self-injury, providing behavior analysts with a framework for involving caregivers as active treatment agents in managing this dangerous class of behavior.

The clinical significance of early intervention for SIB cannot be overstated. Self-injurious behavior, which includes head-banging, self-biting, self-scratching, hair-pulling, and other forms of self-directed physical harm, affects a substantial proportion of individuals with intellectual and developmental disabilities. When SIB emerges in young children, the trajectory without intervention is often one of escalation. Behaviors that begin as relatively mild may become more severe, more frequent, and more resistant to treatment over time. Early intervention, therefore, offers the best opportunity to alter this trajectory and prevent the development of chronic, treatment-resistant SIB.

Parent training is a particularly critical component of early SIB intervention for several reasons. First, parents are the individuals who spend the most time with the child and who are present across the widest range of contexts. A highly effective clinic-based intervention that does not generalize to the home environment provides limited benefit. Second, young children with developmental delays may not yet be enrolled in intensive behavioral services, making parents the primary or sole treatment agents. Third, parents who understand the behavioral principles underlying SIB management are better equipped to respond effectively to novel challenging behaviors as they emerge, rather than only to specific behaviors they have been trained to address.

However, parent training for SIB management is also uniquely challenging. Self-injurious behavior is frightening and distressing for parents, which can lead to high levels of stress, emotional responding that interferes with effective implementation, and avoidance of situations that occasion the behavior. Effective parent training must address these emotional and practical barriers in addition to teaching the specific behavior management procedures.

The research examined in this course demonstrates that parent-implemented interventions can be feasible and effective for addressing early SIB, even with young children who present with significant developmental delays. This finding has important implications for the structure and delivery of behavior-analytic services, suggesting that parent training should be a core component of any comprehensive treatment plan for early SIB rather than an add-on or afterthought.

For behavior analysts, this course reinforces the importance of viewing parents as partners in treatment rather than merely as individuals who need to be taught to follow a behavior plan. Effective parent training empowers caregivers with the knowledge and skills to understand their child's behavior, implement evidence-based strategies, and make informed decisions when unexpected situations arise.

Background & Context

Self-injurious behavior has been a focus of behavior-analytic research for decades, and the literature provides a strong evidence base for assessment and treatment approaches. Functional analysis methodology, developed through extensive research, has demonstrated that SIB is typically maintained by one or more environmental contingencies, including positive reinforcement (attention, tangible access), negative reinforcement (escape from demands or aversive stimulation), or automatic reinforcement (sensory consequences intrinsic to the behavior).

The literature on parent-implemented behavioral interventions has grown substantially, reflecting recognition that generalization and maintenance of treatment gains depend heavily on caregiver implementation. Parent training has been shown to be effective for a range of challenging behaviors, including tantrums, noncompliance, and aggression. However, the application of parent training specifically to SIB in very young children has received less attention, making the Fodstad et al. (2018) study a valuable contribution to the literature.

Several factors make early intervention for SIB particularly important. Research has demonstrated that the longer SIB persists, the more resistant it becomes to treatment. Early SIB in young children may be less firmly established in the behavioral repertoire and may be maintained by simpler reinforcement contingencies, making it more responsive to intervention. Additionally, early intervention can prevent the development of tissue damage, calluses, and other physical consequences that may themselves become reinforcing through automatic reinforcement processes.

The parent training model described in this course aligns with a broader movement in behavior analysis toward naturalistic, family-centered service delivery. Rather than relying exclusively on clinician-delivered intervention in controlled settings, this approach recognizes that effective treatment must occur in the environments where the child lives and that the individuals who are most consistently present in those environments, the parents, must be equipped to implement treatment.

The challenges of parent training for SIB are well-documented in the literature. Parents may have difficulty maintaining procedural fidelity when their child is engaging in behavior that is distressing to observe. The emotional response to watching a child harm themselves can override the parent's training, leading to responses such as excessive soothing, avoidance, or inconsistent application of procedures. Effective parent training must anticipate and address these challenges through graduated exposure, clear written protocols, in-session coaching, and ongoing support.

The study also highlights the importance of conducting functional assessment as a foundation for parent training. When parents understand why their child engages in SIB, specifically what environmental contingencies maintain it, they are better positioned to implement function-based interventions consistently. Without this understanding, parents may apply generic behavior management strategies that do not match the function of the behavior and that are therefore unlikely to be effective.

Clinical Implications

The clinical implications of this research extend across multiple dimensions of behavior-analytic service delivery, from assessment through intervention design, parent training methodology, and outcome evaluation.

The first major implication is that functional assessment should be the foundation of any parent training program targeting SIB. Parents need to understand not just what to do but why they are doing it. When a parent understands that their child's head-banging is maintained by escape from demands, they can understand why planned ignoring alone might not work (because the behavior is not maintained by attention) and why a different strategy, such as demand fading or functional communication training, is appropriate. This functional understanding also helps parents generalize their skills to new situations, because they can identify the contingencies operating in novel contexts.

The second implication involves the structure of parent training. Effective training requires more than instruction. The literature supports a behavioral skills training (BST) model that includes instruction, modeling, rehearsal, and feedback. For SIB management specifically, the rehearsal component is critical because parents need to practice responding to SIB in real time. Role-playing scenarios, in which the clinician simulates the child's behavior and the parent practices the correct response, builds fluency that is needed when the actual behavior occurs.

The third implication is the importance of in-vivo coaching. Parents may demonstrate correct responses during training but struggle to maintain them during actual episodes of SIB. In-vivo coaching, in which the clinician observes the parent-child interaction and provides real-time guidance, bridges the gap between training and independent implementation. This coaching can be gradually faded as the parent demonstrates consistent fidelity.

The fourth implication involves addressing parent stress and emotional responses. Parents of children with SIB experience elevated levels of stress, anxiety, and depression. These emotional responses can interfere with treatment implementation and should be addressed as part of the parent training program. This does not mean that behavior analysts should provide therapy for parent mental health, which is outside the scope of practice, but rather that they should acknowledge the emotional difficulty of managing SIB, provide strategies for self-management during challenging episodes, and refer parents to appropriate mental health support when needed.

The fifth implication is the need for ongoing monitoring of both child behavior and parent implementation fidelity. Treatment gains for SIB can be fragile, and regression is possible, particularly during periods of stress, illness, or environmental change. Regular fidelity checks and booster training sessions help maintain treatment effects over time.

The sixth implication involves the timing of intervention. This research supports the argument for early intervention, demonstrating that parent-implemented interventions can be effective with very young children. Behavior analysts should advocate for early assessment and treatment of SIB rather than adopting a wait-and-see approach that allows the behavior to become more established and more resistant to treatment.

Finally, the research highlights the feasibility of parent-implemented SIB interventions. Some clinicians may be reluctant to involve parents in SIB management due to concerns about safety or fidelity. This research provides evidence that with appropriate training and support, parents can be effective treatment agents for even this serious class of behavior.

Ethical Considerations

Parent training for self-injurious behavior involves multiple ethical considerations that behavior analysts must navigate carefully. The BACB Ethics Code for Behavior Analysts (2022) provides guidance across several relevant domains.

Code 2.01 (Providing Effective Treatment) requires behavior analysts to prioritize evidence-based interventions. Parent training based on functional assessment results is consistent with this requirement, as it combines two well-supported approaches: function-based intervention and caregiver training. When designing parent training programs, behavior analysts should ensure that the strategies taught to parents are grounded in the current evidence base and are appropriate for the specific function of the child's SIB.

Code 2.14 (Selecting, Designing, and Implementing Behavior-Change Interventions) requires interventions to be conceptually consistent with behavior-analytic principles and to be the least restrictive effective option. Parent training inherently promotes a least restrictive approach by building the child's support system within the natural environment rather than relying on more restrictive clinical settings. However, behavior analysts must ensure that the specific procedures taught to parents are appropriate for the child's age, developmental level, and the severity of the SIB.

Code 2.09 (Involving Clients and Stakeholders) requires behavior analysts to involve caregivers in treatment planning and implementation. Parent training is a direct expression of this ethical obligation. However, this code also implies that parents should be informed about the rationale for the procedures, the expected outcomes, and any risks associated with implementation. For SIB management, this includes discussing the possibility of extinction bursts and the importance of maintaining consistency through them.

Code 2.15 (Minimizing Risk of Behavior-Change Interventions) is critically important when addressing SIB. Any intervention that involves withholding reinforcement for SIB (such as planned ignoring during extinction) carries the risk of an extinction burst, during which the behavior may temporarily increase in frequency, duration, or intensity. Parents must be fully informed about this possibility and must be trained to respond safely during extinction bursts. The behavior analyst must also assess whether the environment is safe for the child during potential increases in SIB intensity.

Code 4.01 (Compliance with Supervision Requirements) is relevant because parent training for SIB requires careful supervision of the parent's implementation. The behavior analyst must ensure that parents are implementing procedures correctly and that the child is safe. This may require more frequent supervision sessions, in-home observation, and ongoing fidelity assessment.

Code 1.07 (Cultural Responsiveness and Diversity) requires behavior analysts to consider cultural factors that may influence parent training. Cultural beliefs about disability, child-rearing, and help-seeking may affect how parents respond to parent training. Some families may be uncomfortable with certain procedures or may have concerns about the assessment process. The behavior analyst must adapt the training approach to be culturally responsive while maintaining the integrity of the evidence-based procedures.

Code 2.18 (Continual Evaluation of the Behavior-Change Program) requires ongoing data collection and program modification. This is particularly important for SIB, where treatment failures can result in physical harm. Data should be collected on both the child's SIB and the parent's implementation fidelity, and the treatment plan should be modified if the data indicate that desired outcomes are not being achieved.

Assessment & Decision-Making

Effective parent training for SIB requires a comprehensive assessment process that evaluates the child's behavior, the parent's current skills and resources, the home environment, and the feasibility of proposed interventions within the family's daily routine.

Assessment of the child's SIB should begin with a thorough functional behavior assessment. For young children with developmental delays, this typically includes indirect assessment through parent and caregiver interviews, descriptive assessment through direct observation in natural settings, and, when appropriate and safe, functional analysis. The functional assessment identifies the maintaining contingencies for the SIB, which directly informs the intervention strategies that will be taught to parents.

For very young children, functional assessment may need to be adapted. Standard functional analysis conditions may not be appropriate for children under two years of age, and the topographies of SIB in very young children may differ from those in older individuals. Clinicians should consider using brief functional analysis procedures, trial-based functional analysis, or descriptive assessment with conditional probability analysis as alternatives to extended functional analysis.

Assessment of the parent's current skills should include their understanding of behavioral principles, their current responses to SIB episodes, their ability to follow through with procedures during challenging episodes, and any barriers to implementation. This assessment can be conducted through interview, direct observation of parent-child interaction, and structured skills assessment. Understanding the parent's starting point allows the clinician to tailor the training to the parent's needs rather than using a one-size-fits-all approach.

Assessment of the home environment should identify potential safety concerns during SIB episodes and during intervention implementation. This includes evaluating the physical environment for hazards that could increase the risk of injury during SIB, the availability of materials needed for intervention (such as communication devices for functional communication training), and the presence of other children or family members who may affect implementation.

Assessment of feasibility is critical for parent training success. Interventions that require constant vigilance, complex multi-step procedures, or significant disruption to the family's routine are less likely to be implemented with fidelity. The clinician should work with the family to design interventions that are effective, safe, and realistic within the context of their daily life.

Decision-making about intervention selection should be guided by the functional assessment results, the parent's capabilities and resources, and the severity and risk level of the SIB. For SIB maintained by social reinforcement, functional communication training combined with extinction is typically the treatment of choice. For SIB maintained by automatic reinforcement, matched stimulation and environmental enrichment may be appropriate. For SIB with multiple functions, a comprehensive treatment package addressing each function may be needed.

The decision about how much parent training is needed should be based on the complexity of the intervention, the parent's baseline skills, and the severity of the SIB. More complex interventions, less experienced parents, and more severe SIB all warrant more intensive training with more frequent coaching sessions and fidelity checks.

What This Means for Your Practice

This course underscores a critical message for behavior analysts: parents are not passive recipients of behavior plans but active treatment agents whose skills directly determine treatment outcomes, particularly for self-injurious behavior in young children.

When you encounter SIB in a young child, act early. Do not adopt a wait-and-see approach. Conduct a thorough functional assessment, design a function-based intervention, and train parents to implement it with fidelity. The window for preventing SIB from becoming chronic is narrow, and early intervention is your best opportunity.

Use behavioral skills training (instruction, modeling, rehearsal, feedback) rather than relying on verbal instruction alone. Parents need to practice responding to SIB before they encounter it in real time. In-vivo coaching bridges the gap between training and independent implementation.

Address the emotional dimension of parent training for SIB. Acknowledge that watching your child hurt themselves is distressing. Provide strategies for self-management during challenging episodes. Refer parents to appropriate mental health support when needed.

Monitor both the child's behavior and the parent's fidelity. Treatment gains for SIB can erode if implementation fidelity drops. Regular fidelity checks and booster sessions maintain treatment effects over time.

Finally, prepare parents for extinction bursts. If the intervention involves extinction, parents must understand that behavior may temporarily worsen before it improves. This preparation, combined with safety planning, prevents premature abandonment of effective treatment.