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--- content:self_injurious_behaviour [2024/03/28 13:34] – biju.hameed@gmail.com
+++ content:self_injurious_behaviour [2024/03/28 14:11] (current) – biju.hameed@gmail.com
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   * Autism Spectrum Disorders – Behavior Problems for Children[(:cite:matson2008>Matson JL, Gonzalez ML, Rivet TT. Reliability of the Autism Spectrum Disorder-Behavior Problems for Children (ASD-BPC) Research in Autism Spectrum Disorders. 2008;2(4):696–706)]
   * Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)-Part 3[(:cite:matson2009>Matson JL, Wilkins J, Sevin JA, Knight C, Boisjoli JA, Sharp B. Reliability and item content of the baby and infant screen for children with aUtIsm traits (BISCUIT): Parts 1–3. Research in Autism Spectrum Disorders. 2009;3(2):336–344.)]
+==== Behavioral treatments of SIB ====
+  * Antecedent-based intervention strategies
+  * Reinforcement-based intervention strategies
+  * Extinction-based intervention strategies
+  * Punishment-based intervention strategies
+**Antecedent-based intervention strategies**
+There is a wide range of antecedent interventions that have proven to be effective in changing the factors that cause self-injurious behavior in individuals with Autism Spectrum Disorder (ASD).
+  * changing a child’s schedule to avoid, minimize or rearrange challenging parts of the day
+  * Manipulation of sleep schedules
+    * faded bedtime routine to decrease the number of night-time awakenings and associated SIB
+    * inclusion of a nap after a night of reduced sleep that had been related to high rates of SIB
+  * adaptation of demands that may be precursors to SIB. Interspersing simple, high compliance demands amongst more difficult, lower compliance demands
+**Reinforcement-based intervention strategies**
+Reinforcement is the application or removal of stimuli that results in an increase in behavior over time. Noncontingent reinforcement (NCR) involves the presentation of the reinforcing consequence for the problem behavior on a time-based and response-independent schedule.
+if SIB is found to be maintained by social attention, then the reinforcer stimulus provided would be positive social attention from adults or peers. If the behavior is maintained by negative reinforcement, as is the case in escape-maintained behavior, then the reinforcer stimulus provided would be escape (ie, break) from demands.
+Noncontingent negative reinforcement may be composed of providing breaks from demands to an individual with SIB on a fixed schedule so that breaks are no longer provided contingent on SIB.
+**Extinction-based intervention strategies**
+During extinction procedures, the reinforcing consequence that was previously maintaining the SIB is stopped, thereby removing the motivation for the problem behavior. or example, in a case of SIB maintained by social attention, planned ignoring can be employed. For SIB maintained by escape from demands, escape extinction is the appropriate extinction technique to employ.
+In SIB that is maintained by automatic reinforcement (hitting the head for e.g) the behavior itself leads to positive outcomes for the individual, rather than relying on external factors that may be easier to manipulate. When dealing with SIB maintained by automatic reinforcement, the intervention focuses on preventing the sensory experience caused by the behavior. Protective equipment like helmets, gloves, or arm restraints is commonly used to carry out sensory extinction.
+Protective gear is commonly employed in instances of severe SIB to minimize the risk of physical harm.However, wearing protective equipment can also help decrease sensory stimulation during and after an episode of SIB, acting as a way to stop the behavior.The physical restraint employed should limit movement as little as possible while preventing self-injurious behavior.It is important to have a clear plan in place from the beginning of treatment on how to gradually reduce the use of manual restraints.
+Another effective option for treating automatically-maintained SIB is using a competing sensory stimulus that replicates the sensory experience of SIB. For example, a hand massager can be used to mimic the effects of hand mouthing or biting.By offering uninterrupted access to these stimuli, it may reduce the desire to seek reinforcement through self-injurious behavior[(:cite:pmid10738949>{{pmid>long:10738949}})].
+**Punishment-based intervention strategies**
+Punishment is the application or removal of stimuli in order to decrease the likelihood that a particular behavior will occur again in the future. Some of the most commonly studied punishments are: physical restraint, “response reduction” procedures (eg, time-out, facial screens), and the application of aversive stimuli (eg, water misting, aversive odors, brief contingent electric shock).
 ==== References ====