Utilizing increased response effort to reduce chronic hand mouthing

The effects of increased response effort on levels of hand mouthing, leisure engagement, and adaptive elbow flexion were investigated with 2 individuals who had been diagnosed with profound disabilities. Arm restraints designed to alter the amount of physical effort necessary to engage in hand mouthing were used. Results indicated that the treatment strategy reduced levels of hand mouthing but produced only small to moderate reductions in levels of leisure engagement and adaptive elbow flexion. At follow-up, the effects of increased response effort on hand mouthing and leisure engagement were maintained for both participants; however, the restraints were associated with substantial reductions in adaptive elbow flexion for 1 participant. DESCRIPTORS: hand mouthing, self-injurious behavior, response effort, restraint Hand mouthing is a behavior problem observed in about 17 % of individuals with mental retardation, with the highest preva-lence occurring in individuals who have been diagnosed with profound disabilities (Rast & Jack, 1992). Chronic hand mouth-ing can produce a variety of injuries includ-ing tooth loss and infection of the hands and mouth (Rast & Jack). Functional analyses of chronic hand mouthing suggest that the be-havior frequently is maintained by nonsocial (i.e., automatic) sources of reinforcement (Goh et al., 1995). Behaviors maintained by automatic rein-forcement present unique treatment chal-lenges because of the difficulty in identify-ing, manipulating, and controlling the spe-cific reinforcer produced by the response. As We thank the members of Murdoch Center’s Spe-cial Protective Device clinic for their efforts in the construction and modifications of the arm restraints utilized in this study. We thank Rodney E. Realon, James F. Phillips, and Laura Quinn for their review of earlier manuscript drafts. Finally, we thank Michael Hennike, Robert Miller, Alexander M. Myers, and Te-resa Kersey for their administrative support of this re-search project. Correspondence concerning this article should b