Remember the last time you hit your head on something? You probably uttered a variation of Ah, Oh, or Ow, and then drew a long breath through your teeth as you clutched the stinging area of your head. It hurts to hit our heads, and we avoid it at all costs; but is there a situation in which someone would intentionally cause themselves harm? I’m not talking S&M. I’m talking something far more dire.
A certain number of those who are autistic or otherwise mentally disabled engage in some sort of self injurious behavior, SIB for short. Such individuals may hit their heads, bite their hands, bite their lips and tongues, pick at their skin, or find any other way to hurt themselves. These are also not isolated incidences that happen, say, once a week. Some individuals might sit down and hit their heads around a thousand times in one minute. There will be a break for some time, and then he will sit down and hit his head again. SIB can start in early childhood, and last a lifetime if not treated. It seems unbelievable; it is true, and truly horrible.
You probably ask: Why would anyone intentionally hurt themselves? That is a good question. The question, in fact. And figuring out the answer to that question leads us to the solution of how to stop individuals from engaging in self injurious behavior. The process of figuring out what sustains a behavior is called a “functional analysis”. You are determining the function, the purpose of the behavior. You are figuring out how it reinforces the behavior so that the person does it again and again.
During the functional analysis, you would identify potential causes of the behavior. Then, you would create scenarios, one by one, where you present only one of those potential causes to the person with SIB (Iwata et. al, 1994). There will, undoubtedly, be a difference in the frequency of SIB between the conditions that will tell you what the function of the SIB is for that particular individual.
Some people use SIB to get a break from what they are being expected to do. They know that the moment they hit themselves, the person making them do something will stop. Others simply want some sort of attention and interaction. The moment the SIB starts, a caretaker will try and stop it, saying, “No, stop. You’ll hurt yourself.”
For those who have a limited ability to speak, SIB is a form of communication. For instances such as these, where the behavior is externally reinforced (someone else provides the reinforcement), behavior analysts can compete with the reinforcer or teach the individual how to get the reinforcer through means other than self injury. SIB patients can be taught to hold up a card or use sign language to communicate when they want a break or they want attention.
It is also important to make the individual WANTS to learn the new skill of communicating. The way to do this is to put the self injurious behavior on extinction. This means that the individual does not get access to the reinforcer that they want if they engage in SIB. If the SIB is sustained by attention, then the person must not be given any attention when they are injuring themselves.
If the behavior is sustained by obtaining a break from their current task, the person must not be given that break (at least until that break or attention will not be associated with the SIB by the individual). This does not mean that the person does not get attention at all or is expected to work 24/7. The individuals must simply understand that they will not get what they want if they engage in SIB.
One method of reinforcing behavior other than the unwanted SIB is called non-contingent reinforcement. This means (for example) that the person would get love and attention all the time for absolutely free… except when they hurt themselves.
There are times, though, where the thing that reinforces the SIB does not come from another person. At times, a person engages in SIB for internal reasons. They may hit their head or bite their hands to alleviate a pain that is already there. They may have a headache or, tragically, have a build-up of acid in their extremities.
On the flip side, they may hit their head to experience the subsequent rush of endorphins. This type of SIB is very difficult to deal with, because it is hard to compete with an escape from pain or a rush of endorphins.
How then, can we stop these individuals from engaging in a behavior almost like an addiction, that is slowly killing them? There is one method that was as effective as it was controversial, though controversial, perhaps, because the opposition was ill-informed and not fully grasping what the treatment actually entailed or what it treated. Be informed! Read about SIBIS in “The Question of Ethics”.
Unfortunately, there are two more reasons why a person might engage in SIB. The reasons we discussed so far are socially reinforced. The reinforcement that the individual receives comes from someone else. In some cases, the reinforcement for SIB is automatic. It is internal to the person. Such people might hit their heads to experience the euphoric rush of endorphins, or, tragically, to escape a pain they already have in their bodies. Some individuals with SIB seem to get a build-up of acid in their extremities.
It is very difficult to compete with an escape from pain or a rush of endorphins with external reinforcers. Because no such treatments are effective, individuals with SIB to this extent are restrained and/or medicated into a state where they cannot hurt themselves.
There is, however, a treatment that has shown to be as effective as it is controversial. Doctor Iwata and his colleagues developed a device that could be worn by an individual with SIB. It would sense a blow great enough to cause injury, and deliver an electric shock to the arm or leg as a quick and highly contingent punishment.
This is where the controversy comes in. the moment people hear the word electric shock, or even punishment for that matter, the ethics siren goes off. In the interest of being truthful, yes, the SIBIS device that Dr. Iwata created delivers and electric shock, but it apparently is only strong enough to feel like a firm pinch from someone’s fingers. There is also little chance that the individual will set the device off during everyday activities. Dr. Iwata played tennis wearing the SIBIS apparatus when he was developing it.
It is also important to consider the fact that individuals who engage in SIB are slowly killing themselves. They are either constantly causing themselves physical damage, or they are so restrained that they can do very few of the enjoyable things in life.
SIBIS does not physically damage the individual, and what’s more, SIBIS works. Individuals who have engaged in SIB for most of their lives can put SIBIS on and stop engaging in SIB in a very short time span. Also, don’t the individuals themselves have a say in this?
One of the fascinating things about SIB is that individuals often try to stop themselves from causing themselves harm. They will sit on their hands and try to stay still. SIB is like an addiction, however. The individuals want to stop, but they cannot stop on their own, so those who have worn SIBIS wear it willingly. I know that I would take a pinch on the arm or two to get my life back.
Iwata, B. A., M. F. Dorsey, et al. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209.
- Do No Harm (appliedbehavioralstrategies.wordpress.com)
- Why Self-injuious Behavior? (asthependulumswings.wordpress.com)
- Operate in the Best Interest of the Client (appliedbehavioralstrategies.wordpress.com)
- What is The Good Behavior Game? (appliedbehavioralstrategies.wordpress.com)
- Be a Behavior Detective (psychologytoday.com)
- Behavior Support for Adults with Disabilities (appliedbehavioralstrategies.wordpress.com)
- Positive Or Negative Reinforcement – What Works Best (anotherhallucination.com)
- Using ABA in General Education (appliedbehavioralstrategies.wordpress.com)
- Ideology: Behavior protocol or excuse? (blametheamygdala.wordpress.com)
- Reactance, Day I: Awareness (sebastianmarshall.com)