Nonaversive treatment of severe self-injurious behavior: multiple replications with DRO and DRI

Sixteen severely self-injurious residents of a state mental retardation facility were treated with conventional, non-aversive behavior modification techniques by the same staff over a four-year period. Although each resident had performed multiple self-injuries prior to treatment, including blindness, multiple permanent scars, punctured eardrums, etc., 12 of the 16 improved in terms of decreased frequency of self-injurious behavior (SIB) and decreased frequency of measurable physical injury; of these, seven ceased SIB altogether. Each resident's treatment was unique, which necessitated unique analyses of controlling antecedents and maintaining consequences. Two exclusive types of self-injurious residents became evident: a) those whose SIB was maintained by socially reinforcing consequences and b) those whose SIB was maintained by escape contingencies. The study suggests that in agencies where intensely aversive techniques cannot be used to treat SIB, occasional restraint control of behavior can be combined with intensive differential reinforcement of other (DRO) or incompatible (DRI) behavior to produce an extended but satisfactory probability of successful treatment. Similar to published results from intensely aversive treatment, mildly aversive treatment, which largely depended upon positive reinforcement of desirable alternative behaviors, did not completely suppress the most severe SIB.