Using Self-Monitoring to Address Self-Injurious Behavior

Self-injurious behavior (SIB) can be extremely difficult to deal with in terms of watching someone we love physically hurt themselves and in terms of treatment. SIB often refers to any behavior that can cause tissue damage, such as bruises, redness, and open wounds. The most common forms of these behaviors include head-banging, hand-biting, and excessive scratching or rubbing. (SIDE NOTE: SIB in people with autism should not be confused with SIB in people with other mental disorders which may include self-cutting and other forms of self-mutilation.)

From: https://www.help.co.uk/user_images/Biting%20hand%20Boy.JPG

Self-injury can serve a variety of functions dependent on the person exhibiting the behavior and what consequences are reinforcing the behavior. The behavior could be caused by automatic reinforcement (i.e. the release of the opiate-like beta-endorphins), sub-clinical seizures, middle-ear infections (head or ear hitting may relieve pain), self-stimulation, attention-seeking or task/demand avoidance. Depending on the cause of the SIB there are various treatment options. It is very important to rule out physical causes of behavior (i.e. seizures or infections) before attempting behavioral-based treatments because these medical causes need to be treated in a different way.

Some forms of SIB may be able to be treated using a self-monitoring program which reinforces the absence of behavior. In a study conducted by Jeffery H. Tiger, Wayne W. Fisher and Kelly J. Bouxsein (published in the Journal of Applied Behavior Analysis, Summer 2009) they researched whether or not a self-monitoring program effectively reduced the SIB of a young man with Asperger’s. They first started by informing the participant about the program details and helping him identify instances of SIB. The SIB he engaged in was skin-picking which caused him to bleed.

The program was initially implemented by a therapist. During therapy sessions a timer would be set for a given amount of time (5, 10 or 15 minutes) and if at the end of that time he had not engaged in skin-picking he would receive a token (tokens were exchangeable for money). If he did engage in skin picking the timer would be reset. After 12 session in which the therapist was administering reinforcement, the participant was then taught how to use the timer and administer reinforcement to himself. During all 29 sessions (including some data recorded outside of the therapy environment without the therapist present for generalization) the participant rarely engaged in SIB. On a follow-up visit it was anecdotally noted that his skin-appearance had improved and there was little evidence of continuation of the SIB at the high levels previously seen (in this study there was no formal generalization and maintenance data collected).

Self-monitoring systems can be very effective because it helps the person become more self-aware of the behavior and teaches them to engage in self-control and self-reinforcement. Another benefit of this type of intervention is that it decreases the amount of monitoring needed from an outside source (i.e. parent, teacher or therapist). These types of intervention may be more powerful and long-lasting because the person is exhibiting control over themselves and not being “controlled” by others which may have unwanted consequences (i.e. the person only refrains from engaging in the behavior when the controlling person is around).

2. Are you having problems at home or in the community with SIB? Share your story here and hopefully someone from the community can help.