Application of the augmented competing stimulus assessment to identify and establish competing self-restraint items

Automatically maintained self-injurious behavior (SIB) sometimes co-occurs with self-restraint, a self-limiting behavior that impedes SIB and can be maladaptive (e.g., hinders functional skills and movement). The presence of self-restraint suggests SIB produces aversive consequences, which self-restraint limits. We conducted a prospective consecutive controlled case series study of five individuals with Subtype 3 automatically maintained SIB where we applied the augmented competing stimulus assessment to identify and establish alternative self-restraint items to compete with existing forms of self-restraint. At least one high-competition item that produced an 80% or greater reduction in self-restraint and SIB without disrupting toy engagement was identified for the four participants who completed assessment. We discuss the need for additional research on this procedure and how competing self-restraint items can be used in combination with competing stimuli and tasks to address SIB and self-restraint. We also discuss some avenues for research that is directed at understanding the mechanisms of self-restraint.