A Multi-Component Approach to Reducing Self-injury in the Natural Environment

Past research has demonstrated that a variety of medical/pharmacological and behavioral strategies may be effective at reducing self-injury for adults with intellectual and developmental disabilities. Unfortunately, the effectiveness of these interventions is rarely evaluated in the natural environment. Also, teachers, who are responsible for the care of these individuals, are often not adequately trained in the use of these procedures. The purpose of the present study was to evaluate treatments for reducing self-injury that combine both behavioral and medical components in the natural environment with a comprehensive staff training package. Three participants (ages 15-48) diagnosed with a profound IDD/autism, who engaged in severe self-injury, participated. A multi-component treatment package was developed for all participants including 1) reinforcing the absence of self-injury and reinforcing communication, 2) blocking self-injury with redirection to appropriate activities, 3) environmental enrichment, and 4) an individualized intervention to address medical and biological influences on self-injury. After the effectiveness of this intervention package was demonstrated, a staff-training package that included feedback and contingent money was evaluated with three of the participants' teachers. The multi-component package was effective at reducing self-injury by 50% for all participants when implemented by the investigators. All teachers were able to consistently implement the intervention plan and produce reductions in self-injury when they received feedback and money regarding their use of the procedures. The multi-component intervention was effective at reducing self-injury and teachers were able to consistently use the intervention in the natural environment. Teachers should receive consistent feedback regarding their use of the procedures so that reductions in self-injury can be maintained in the absence of the investigator