How do self-injurious behaviors develop?

This month’s ASAT feature comes to us from Ennio Cipani, Ph.D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

I am a new teacher who will have a student with some self-injurious behavior entering my classroom next year. Although his behavioral intervention will be overseen by a board-certified behavior analyst, I would like a general understanding of how certain behaviors develop into self-injury.

Like yourself, many teachers will have contact with students with autism and/or intellectual disabilities who engage in severe and intense forms of self-injury. Indeed, these self-destructive acts seem to defy any reasonable explanation. Common explanations for a student who engages in self-injury have often disregarded an environmental analysis of antecedents (i.e., the events that take place right before the behavior occurs). In some cases, statements are made such as “It comes out of nowhere,” or “She does it because she has autism/intellectual disabilities.”

A behavior analytic model shows us that challenging behavior is functional (i.e., serves a purpose) for the individual and can indeed explain even cases where self-injury has reached such dangerous intensity that it results in soft tissue damage, concussions, etc. But, as you asked, how do such dangerous behaviors develop? Research and anecdotal reports from families have demonstrated that mild forms of self-injurious behavior can start innocuously, and over time, become dangerous in terms of their effect on the person’s health and welfare.

Let’s consider a hypothetical student to demonstrate how events in the student’s environment can reinforce and shape severe self-injurious behavior. Initially, tantrum and screaming behaviors are effective (functional) in producing a desired outcome. These behaviors can result in access to desired items and events, such as candy or a preferred activity or in escape from aversive conditions, such as demands to turn off electronics or complete a non-preferred task. In other words, the tantrum and screaming are effective in producing access to reinforcement. Although the adult responding to such behaviors may feel uncomfortable about “giving in”, tantrum behaviors produce a very uncomfortable and aversive condition for the adult, who then relents in order to get the student to stop the behavior. In what can quickly become a vicious cycle, the student engages in challenging behavior to obtain a desired result. That behavior creates discomfort for the adult. The adult gives the student what he/she wants and the challenging behavior ceases.

How then does an extreme exacerbation of intensity develop and/or the form of the initial challenging behavior change? One scenario is that during one of these tantrums where the desired result has not yet been delivered, the student slaps him or herself. After a brief amount of attention, e.g., “Stop doing that, you are hurting yourself,” the desired outcome also is produced. As you can see, hitting oneself has now become more adaptive than a tantrum of long duration. As the milder forms of behavior fail to result in the desired outcome, behavior intended to obtain reinforcement can become more varied. Regrettably, the teacher now responds to a more intense variation of challenging behavior. The form that achieved the student’s desired result is the increased intensity of self-injury. What was previously a slap to the leg could now transform to multiple slaps to multiple areas of one’s body.

You may have observed that the self-injury often involves hits/slaps to the face/head. Why would this be the case? Ask yourself this: Are you more likely to intervene if the hitting occurs to one’s thigh area or the face? This could result in adults providing reinforcement more quickly or ceasing to place a particular demand on the child when the self-injury is directed at the face or head. If a more dangerous form of self-injury becomes more efficient than milder forms of the behavior at accessing the reinforcer, the probability that the child will engage in the extreme form of the behavior to access that particular reinforcer increases.

In summary, self-injurious behaviors, like other forms of behaviors, can serve a variety of environmental functions, involving both access (to something) and escape/avoidance (from something). The Cipani Behavioral Classification System (BCS) is a pioneering function-based classification system for categorizing problem target behaviors for education and mental health settings (Cipani & Cipani, 2017). It provides a standard framework for identifying functions of problem behavior. This unique diagnostic classification system identifies the four basic (operant) behavior functions (originally specified in Cipani,1990,1994). It then derives 13 different function-based categories within those four functions.

A functional perspective of self-injurious behaviors can lead to a more effective and efficient treatment. It is important to examine the environmental variables that occur at the time of the self-injurious behavior to determine the function of the behavior. If that function can be determined, then the student can be taught safer, socially acceptable ways to get his or her needs met. Your board-certified behavior analyst should be able to assist you in developing a comprehensive set of strategies based on the underlying function that the self-injury serves for your student.

References

Cipani, E. (1990). The communicative function hypothesis: An operant behavior perspective. Journal of Behavior Therapy and Experimental Psychiatry, 21, 239-247.
Cipani, E. (1994). Treating children’s severe behavior disorders: A behavioral diagnostic system. Journal of Behavior Therapy and Experimental Psychiatry, 25, 293-300.
Cipani, E., & Cipani, A. (2017). A behavioral classification system for problem behaviors in schools: Diagnostic manual (1st edition). New York: Springer Publishing.

Editor’s Note: This article has been adapted and shortened with permission from Behavior Development Solutions and the author. Please see the “Ask Cipani” column to read more articles authored by Dr. Cipani. For more information about functional analysis, please see a previously published Clinical Corner article authored by Dr. Robert LaRue.


About The Author

Ennio Cipani, Ph.D. is a licensed psychologist since 1983 in California. Dr. Cipani has been doing in-home and in-school behavioral consultation for families facing child problem behaviors since 1982. He has published numerous articles, chapters, books and software in the areas of child behavior management and parent and teacher behavioral consultation. His most recent book (Cipani & Cipani, 2019); Cipani Behavioral Classification System for Children and Adolescents: Diagnostic Manual (2nd edition) can be obtained for free in pdf form by emailing him at ennioc26@hotmail.com

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