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

A Comprehensive Guide to Extinction and Minimizing Harm in Behavior Analysis

Overview & Clinical Significance

The relationship between extinction procedures and the concept of harm reduction represents one of the most important evolving conversations in applied behavior analysis. Traditional behavior analytic practice has relied heavily on extinction as a cornerstone procedure for reducing challenging behavior, yet the application of extinction, particularly with autistic learners, has come under increasing scrutiny from both within the profession and from the disability rights community. The Through Our Eyes panel format, featuring autistic disability rights advocates both within and outside of ABA, brings a critically important perspective to this discussion by centering the lived experiences of the very individuals most affected by these procedures.

The clinical significance of reexamining extinction procedures cannot be overstated. Extinction, which involves removing the reinforcement that maintains a behavior, is a fundamental behavioral principle that is well-established in the research literature. However, the application of extinction in clinical settings involves complexities that extend well beyond the basic principle. Extinction bursts, which involve temporary increases in the frequency, intensity, or variability of the target behavior, can pose safety risks. Extinction-induced aggression is a well-documented phenomenon. The emotional distress associated with having one's communicative attempts ignored, which is what extinction of attention-maintained or escape-maintained behavior often amounts to, raises significant ethical questions about the balance between behavior reduction and individual well-being.

Harm reduction, as a complementary or alternative framework, offers a different lens for addressing challenging behavior. Originating in public health, harm reduction focuses on minimizing the negative consequences of behaviors rather than requiring their complete elimination. Applied to behavior analysis, this approach suggests that for some individuals and some behaviors, the most ethical and practical goal may be reducing the risk and severity of harm associated with a behavior rather than eliminating the behavior entirely. This is particularly relevant for behaviors that serve important communicative or regulatory functions for the individual.

Nyetta Abernathy's presentation through the Through Our Eyes Panel brings the perspective of autistic advocates to this discussion, which is essential because the individuals who experience extinction procedures directly are best positioned to describe their effects. When autistic self-advocates report that having their communication ignored during extinction felt traumatic, or that the suppression of self-regulatory behaviors through extinction left them without coping mechanisms, these are data points that behavior analysts must incorporate into their clinical decision-making.

Background & Context

Extinction has been a central procedure in behavior analysis since the field's earliest days. The basic principle is straightforward: when reinforcement for a behavior is discontinued, the behavior will eventually decrease. In laboratory settings, this principle is reliable and well-documented. In applied settings, however, the implementation of extinction is substantially more complex and carries risks that have received increasing attention.

The historical application of extinction in ABA, particularly in the treatment of challenging behavior in autistic individuals, has included procedures that many now view as ethically problematic. Planned ignoring of attention-maintained behavior, for example, involves systematically withholding attention when an individual engages in challenging behavior. While this may be technically accurate as an extinction procedure, it can be experienced by the individual as rejection, abandonment, or emotional neglect. When the challenging behavior serves a communicative function, extinction can effectively punish communication attempts, even if that is not the clinician's intent.

The harm reduction framework emerged in the public health field, primarily in response to substance use. Rather than requiring abstinence as the only acceptable outcome, harm reduction acknowledges that complete elimination of a behavior may not be realistic or desirable for every individual and focuses instead on reducing the risks and negative consequences associated with the behavior. Needle exchange programs, supervised injection sites, and medication-assisted treatment are examples of harm reduction approaches that have strong evidence bases in public health.

Applying the harm reduction framework to behavior analysis represents a paradigm shift that challenges the traditional emphasis on behavior elimination. For behaviors that serve important functions for the individual, such as self-regulation, communication, or coping with sensory overload, a harm reduction approach might focus on teaching safer forms of the behavior, modifying the environment to reduce the likelihood of harm, or developing alternative coping strategies that the individual can use alongside existing behaviors rather than as replacements for them.

The Through Our Eyes panel format is particularly valuable for this topic because it centers the perspectives of autistic individuals, including those who have experienced extinction procedures firsthand. The disability rights principle of nothing about us without us applies directly to discussions about treatment procedures, and the insights of autistic advocates provide essential context that clinical data alone cannot capture. The inclusion of advocates both within and outside of ABA ensures a range of perspectives, from those who see potential for reform within the field to those who challenge its fundamental assumptions.

The current context also includes growing recognition that behavior analysts have an obligation to consider the full spectrum of consequences associated with their procedures, not just the primary outcome of behavior reduction. When extinction reduces a target behavior but increases anxiety, damages trust, or eliminates an important coping mechanism, the overall effect on the individual's well-being may be negative.

Clinical Implications

Reconsidering the use of extinction and incorporating harm reduction principles into clinical practice has far-reaching implications for how behavior analysts assess, plan, and implement interventions for challenging behavior.

Assessment practices should expand to include a thorough understanding of the functions served by the behavior not only in behavioral terms but in experiential terms. A behavior that is maintained by escape from demands may also serve as the individual's primary coping mechanism for managing sensory overload, anxiety, or other internal experiences. A functional behavior assessment that identifies the behavioral function without exploring the experiential context may lead to an intervention that addresses the contingency but ignores the underlying need. Including the individual's perspective on their own behavior, to the extent possible, provides information that traditional FBA methods may miss.

When considering intervention approaches, behavior analysts should evaluate whether extinction is the most appropriate and least harmful option for each specific case. Questions to consider include: What are the likely side effects of implementing extinction for this behavior? Is an extinction burst likely, and if so, what safety risks does it pose? Does the individual have adequate alternative behaviors that serve the same function? Will the individual experience the extinction procedure as harmful, distressing, or traumatic? Can the goals of behavior reduction be achieved through less restrictive approaches such as differential reinforcement, environmental modification, or skill building?

Harm reduction approaches offer concrete alternatives for situations where full extinction may not be appropriate. For self-injurious behavior, harm reduction might involve modifying the environment to reduce the severity of injuries rather than eliminating the behavior entirely while simultaneously teaching alternative coping strategies. For elopement, harm reduction might focus on creating safe environments and teaching the individual to communicate their need for space rather than attempting to extinguish the elopement response entirely. For disruptive behavior that serves a communicative function, harm reduction might involve teaching the individual more effective communication while tolerating some level of the original behavior during the transition.

The timeline for behavior change is an important clinical consideration within a harm reduction framework. Traditional approaches often aim for rapid behavior reduction, which may require more intensive and potentially more aversive procedures. Harm reduction acknowledges that meaningful change may occur gradually and that intermediate steps toward safer behavior are valuable outcomes in themselves. This perspective is particularly relevant for individuals with long histories of challenging behavior, for whom expecting immediate change may be unrealistic and counterproductive.

Monitoring for unintended negative effects should be a routine component of any intervention that involves extinction or behavior reduction. This includes monitoring for increases in other challenging behaviors, signs of emotional distress, changes in the individual's engagement with therapy or their environment, and reports from caregivers or the individual themselves about how the intervention is affecting their daily life. When negative effects are detected, the intervention should be modified, even if the primary target behavior is decreasing.

Ethical Considerations

The ethical dimensions of extinction and harm reduction in behavior analysis are significant and multifaceted, requiring behavior analysts to navigate complex tensions between competing values and obligations.

Code 2.14 of the BACB Ethics Code establishes the importance of using least restrictive procedures and recommending reinforcement-based procedures before considering those that involve restriction or removal of reinforcement. Extinction, while not involving the direct application of an aversive stimulus, does involve the removal of reinforcement and can produce aversive side effects including extinction bursts, extinction-induced aggression, and emotional distress. A thorough application of Code 2.14 requires behavior analysts to consider whether reinforcement-based approaches alone, such as differential reinforcement of alternative behavior (DRA) or functional communication training (FCT) without an extinction component, could achieve the treatment goals.

Code 2.01 requires that services be in the best interest of the client. Determining best interest in the context of extinction requires consideration of both the benefits of behavior reduction and the potential costs of the procedure. If extinction reduces a behavior that causes harm but simultaneously damages the individual's trust in their service providers or eliminates a coping mechanism without providing an adequate replacement, the net effect on the individual's well-being may not be positive. Best interest must be evaluated holistically, not solely in terms of the target behavior.

Code 2.09 on involving clients in treatment planning is particularly relevant. For individuals who can communicate their preferences about treatment procedures, their input should be sought and given significant weight. If an individual expresses distress about an extinction procedure or indicates a preference for a different approach, behavior analysts have an ethical obligation to take that preference seriously. For individuals who cannot communicate their preferences verbally, behavior analysts should monitor behavioral indicators of preference and well-being.

Code 2.12 requires behavior analysts to obtain informed consent before implementing interventions. Informed consent for procedures that involve extinction must include clear information about the potential for extinction bursts, extinction-induced aggression, emotional distress, and other side effects. Families and authorized representatives should understand what the procedure will look like in practice, not just its technical definition. Many families report that they were not adequately prepared for the realities of extinction implementation, which raises questions about the quality of informed consent.

The inclusion of autistic voices in clinical decision-making is both an ethical obligation and a practical necessity. The Through Our Eyes panel format models a practice that behavior analysts should integrate into their own clinical work: seeking and genuinely considering the perspectives of the individuals most affected by their procedures. Code 1.07 on cultural responsiveness extends to neurodivergent culture, and the perspectives of autistic self-advocates represent essential data for ethical decision-making about extinction and harm reduction.

Code 1.01 requires behavior analysts to actively promote the well-being of their clients. When the evidence suggests that a procedure may cause harm, even if it also produces benefits, the behavior analyst must weigh these outcomes carefully and be willing to modify or discontinue the procedure when the costs outweigh the benefits.

Assessment & Decision-Making

Making informed clinical decisions about the use of extinction and harm reduction approaches requires a structured framework that considers multiple factors simultaneously.

Begin each case with a comprehensive assessment that goes beyond traditional functional behavior assessment. In addition to identifying the maintaining variables for the challenging behavior, assess the individual's current repertoire of coping and communication skills, their history with extinction procedures, their ability to tolerate frustration and delayed reinforcement, the safety risks associated with potential extinction bursts, and the perspectives of the individual and their support network on the proposed approach.

Develop a hierarchy of intervention approaches that starts with the least restrictive options. Before implementing extinction, consider whether the behavior can be addressed through environmental modification alone, whether antecedent-based interventions could prevent the behavior from occurring, whether differential reinforcement without an extinction component could achieve the treatment goals, and whether teaching alternative behaviors could reduce the need for the challenging behavior without requiring its elimination.

When extinction is being considered, conduct a thorough risk-benefit analysis specific to the individual case. Estimate the likely severity and duration of the extinction burst, identify safety measures that must be in place before implementation begins, assess whether the individual and their support network can consistently implement the extinction procedure across all relevant settings, and evaluate whether adequate replacement behaviors have been established. If these conditions cannot be met, extinction may not be appropriate regardless of its theoretical effectiveness.

Consider harm reduction as either a primary approach or as an intermediate step. For some individuals, harm reduction may be the most appropriate long-term approach, particularly when the behavior serves important communicative or regulatory functions that cannot be fully replaced. For others, harm reduction may be a stepping stone toward further behavior change, providing safety while the individual develops the skills needed for more comprehensive change.

Seek input from the individual whenever possible. Ask them, or help them communicate, how they experience the challenging behavior, what they believe triggers it, what has helped in the past, and what approaches they would be willing to try. This input is not just ethically important; it provides clinical information that can inform more effective interventions.

Monitor outcomes using multiple measures that capture both behavior change and well-being. Track the target behavior, but also track measures of emotional well-being, engagement, quality of life, and the individual's own reports of how they are doing. If behavior data show improvement but well-being measures show decline, reconsider the approach.

What This Means for Your Practice

The conversation about extinction and harm reduction challenges behavior analysts to examine some of the most deeply held assumptions of their training. If you were trained to view extinction as a standard, default procedure for addressing challenging behavior, this reexamination may feel uncomfortable. That discomfort is productive; it signals that you are engaging with perspectives that can improve your practice.

Review your current use of extinction procedures across your caseload. For each case where extinction is part of the treatment plan, ask: Is this the least restrictive approach that could achieve the treatment goals? Has the individual or their representative been fully informed about the potential side effects? Am I monitoring for unintended negative effects? Would a harm reduction approach better serve this individual's overall well-being?

Seek out the perspectives of autistic self-advocates and disability rights advocates. Read their published work, attend presentations like the Through Our Eyes panel, and genuinely consider their critiques of behavior analytic practices. These perspectives do not invalidate behavior analysis as a science, but they challenge practitioners to apply the science more thoughtfully and humanely.

Develop your competence in alternative approaches. If your training emphasized extinction as the primary approach to behavior reduction, invest in learning about antecedent-based interventions, environmental modifications, functional communication training without extinction, and harm reduction strategies. The broader your intervention repertoire, the better equipped you are to serve each individual's unique needs.

Finally, practice ethical courage. If you believe that an extinction procedure is not in a client's best interest, speak up, even when organizational culture or team expectations push in a different direction. The individuals you serve depend on your willingness to advocate for approaches that genuinely serve their well-being.