Literature Review on Self-Injurious Behavior as Target Behavior on ABA

1 Literature Review on Self-Injurious Behavior as Target Behavior on ABA Applied behavior analysis (ABA) is a strong platform on which people with autistic spectrum disorder (ASD) and associated catastrophic consequences of this disorder are assisted to live to their fullest potential. Mostly, therapists provide ABA services to children presenting with abnormal behaviors, Autistic symptoms, and developmental abnormalities. However, these services are increasingly being provided to adults. Notably, adults with autistic spectrum disorder attend center-based programs as part of general services for those with developmental disabilities. In these centers, behavioral analysts employ various interventions to reduce inappropriate behaviors and promote positive behavior.

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2 Irrefutably, people with autistic spectrum disorder and other intellectual and developmental disabilities present with numerous challenging behaviors. Self-injurious behavior is one of the common inappropriate behaviors exhibited by these individuals. Although this behavior is associated with poor quality of life and negative social interactions, it has not attracted the necessary widespread attention. However, in the last few years, the debate over the seriousness of self-injurious behavior in people with developmental disabilities and autism has increasingly become intense. Nonetheless, there has been an insignificant empirical or theoretical investigation of self-injury and particularly autism. Erturk, Machalicek, and Drew (2018) noted that this is most likely due to the comorbidity of autism in developmentally disabled groups and further due to the fact that self-injurious behavior seems to be functionally similar in people with autism and those with developmental disorders unrelated to autism.

This literature review examines self-injurious behavior as a major behavioral challenge associated with autism spectrum disorder and its significance to the target behavior. Broad research in this area aims to determine the cause, the function, the impact, and the possible treatment for this behavior. Research and discussion on self-injurious behavior in the target population have turned problematic since the hypothesized etiology influences proposed interventions besides being inherently associated with human rights issues. The paper also highlights the relevant ABA concepts, methodologies and principles for behavioral challenges in research. Importantly, the paper looks into the theoretical underpinnings of the current research in relation to the case study.

ABA principles, concepts, and methodologies for behavioral challenges in research Treating, preventing, and researching various aspects of self-injurious behavior in autistic children are challenging tasks due to the dynamics of this condition. Reid and Parsons (2016)

3 pointed out that treatment and preventive efforts are concentrated on secondary prevention that targets reduction and limitation of SIB development. Researchers, therapists, and instructors utilize a child’s communicative ability, restrictive and repetitive behavior, and other abnormal signs as indicators of SIB. These indicators offer guidance on the best interventions to apply to an individual.

Although researchers agree that behavioral interventions are integral to secondary prevention, the progress of incorporating these interventions into clinical practice is limited (Cooper, Heron & Heward, 2020). Nonetheless, applied behavior analysis remains the best systematic intervention psychologists and researchers employ to understand and improve behavior. It is a person-centered therapeutic approach used by therapists to modify behavior in persons with intellectual disabilities. Reid and Parsons (2016) noted that ABA is an evidencebased means for assisting autistic persons in living to their fullest potential. The principles and concepts of ABA that focus on behavioral change are affected by environmental factors and the learning process.

The ABA strategy is pegged on making realistic changes to the environment to impact an individual’s behavior and reduce negative actions while promoting positive ones. Boesch et al.

(2015) highlighted the importance of analyzing behaviors as they occur to identify antecedents, the behavior, and the consequences of specific actions. This approach is referred to as the ABC model of behavioral modification. ABA calls for the implementation of strategic principles besides environmental modification to enhance and teach a new behavior. In practice, instructors and psychologists must be systematic to identify behaviors that need changing and understand how learning occurs.

4 The ultimate ABA goal is to put in place measures that enhance socially acceptable behaviors. Professionals apply various ABA concepts to accomplish this goal. These concepts include operant conditioning, classical conditioning, and three-term contingency. Behavioral analysts often apply operant conditioning, which constitutes positive and negative reinforcement to enhance behavior change. Researchers have extensively studied reinforcement as an intervention for self-injurious behavior. Cooper, Heron, and Heward (2020), for instance, pointed out that reinforcement is an integral ABA concept used in ASD populations. Therapists and behavioral analysts utilize this concept to augment functional behaviors in persons with behavioral challenges. The analyst identifies and rearranges factors that influence a person’s behavior to ensure appropriate behaviors are reinforced. The conditions persisting when a behavior occurs constitute the first key attributes of reinforcement. The other attributes are the motivation and the desired outcomes and the time between the behavior and the targeted outcome. The analyst needs to learn to strike a balance between these attributes to achieve the intended behavior. Reinforcement increases the odds that the target behavior will occur in the future while decreasing the likelihood of engaging in inappropriate behavior.

The elements of the three-term contingency are the antecedent, behavior, and action.

Antecedent describes the condition that precedes behavior while the behavior is the action.

Consequence refers to the event occurring after an action (Hill, Mantzoros & Taylor, 2020).

Comparing theoretical underpinnings of research related to the case study Wester et al. (2015) noted that self-injurious behaviors have become a key area of concern in autistic individuals. Researchers are unsure of the factors contributing to self-harm in autism and the most effective interventions to avert these behavioral problems. However, research findings from different sources associate self-injurious behavior in autistic people to

5 various factors, including environment, abnormal functioning communication, limited cognitive ability, age, abnormal social functioning, compulsions, rejection and the need for sameness. This list is not exhaustive and research is focused on finding the link between autism and problem behaviors such as self-injurious behavior and determining the best ways to cut this link.

Summers et al. (2017) pointed out that self-injurious behaviors are common symptoms in people with various psychiatric conditions such as borderline personality disorder. The selfinjurious activities portrayed by these individuals are similar to those presented in autism. Thus, Summers et al. (2017) postulated that the biological elements leading to self-harm in borderline personality disorder are similar to autistic spectrum disorder. The researchers noted that Selfinjurious behavior in these populations is most likely caused by impulsivity, inadequate coping skills, and emotional dysregulation. Individuals engage in self-harm as a way of bringing relief, attracting attention, and gaining control over negative emotions. Summers et al. (2017) highlighted that autistic women are more likely to engage in self-injurious behavior than men.

However, the researchers did not provide the reasoning behind this perception. This view indicates a need for further research.

Erturk, Machalicek, and Drew (2018) noted that self-injurious behavior in the ASD group is unlikely to involve simple determinants. The researchers noted that numerous and cooccurring factors might be involved in the emergence, presence, consequences, and maintenance of this destructive behavior. Personal and environmental factors were also reported to predispose an ASD child to a greater risk of chronic self-injurious behavior (Erturk, Machalicek & Drew, 2018). Therefore therapists need to perform a comprehensive behavioral analysis to identify the risk factors of SIB in a child to implement effective preventive measures and ensure that intervention targets are suitably ascertained.

6 Research findings also indicate that rejection is a potential contributor to SIB in ASD populations. Quirk, Wier, Martin, and Christian (2015) noted that rejecting caregivers triggers the development of maladaptive schemas, specific motives and rumination for different, selfdestructive behaviors. Literature shows that individuals who experienced parental rejection are more likely to demonstrate self-injurious behavior than people brought up by both parents.

Similarly, ASD persons, who face rejection, may develop SIB (Quirk, Wier, Martin & Christian, 2015).

Unlike Quirk, Wier, Martin, and Christian (2015), who used rejection, Licence, Oliver, Moss and Richards (2020) used the developmental psychopathology framework to explain the self-injurious behavior in ASD populations. The researchers noted that ASD populations present a greater risk of developing psychiatric disorders and inappropriate behaviors than other health problems. The researchers also pointed out that the SIB in ASD is different from other neurotypical disorders. However, the researchers pointed out that traumatic experiences are major triggers for self-injurious behavior. They identified SIB as a compensatory strategy in posttraumatic adaptation for ASD and other developmental disabilities.

Evaluating Research studies to distinguish benefits, strengths, and weaknesses in ABA Applied behavioral analysis is a common therapeutic intervention used in persons with an autistic spectrum disorder. ABA has been subjected to extensive studies to determine its purpose and benefits in autism therapy. Research findings support the application of ABA to resolve behavioral challenges in autistic persons. This approach helps autistic persons to learn new behaviors, improve social skills, increase intellectual abilities and adjust to normal life. Research supports the application of ABA to autism treatment and behavioral and mental health improvement. For instance, Morano et al. (2017) noted that teaching and employing treatments

7 based on ABA have positive effects on increasing positive social interactions among autistic children. The researchers noted that autistic persons do not express their feelings, lack social interactions, and portray inappropriate behaviors.

Importantly, Morano et al. (2017) clarified that ABA improves independence and participation in daily life activities. Therapists also use ABA to improve communication, thus, helping autistic persons to express their feelings rather than use self-injurious actions to draw attention. Morano et al. (2017) also noted that some ABA techniques could reduce or replace self-injurious behaviors. In their study, the researchers found out that autistic person performance improved following the integration of ABA into treatment (Morano et al., 2017).

The main challenge associated with ABA is that it produces robotic behaviors, and children are not taught to think independently. The robotic aspect of behaviors produced in ABA is attributable to drills that children are taught to repeat. However, researchers do not believe that behaviors promoted by ABA are robotic. Boesch, Taber-Doughty, Wendt, and Smalts (2015), for instance, argued that the integration of behavioral techniques helps decrease self-injurious behaviors in ASD persons. The researchers noted that autistic children and those with developmental and intellectual disabilities learn social skills through rate and practice which are not natural processes. These children may sound canned since they learn to integrate novel skills into various day-to-day activities. The robotic aspect of these behaviors disappears with time.

Some people consider treating self-injurious behavior and other devastating autism symptoms as unethical. These people argue that applying ABA to autism treatment implies that a child exhibits an abnormal behavior that needs to be changed. Detractors believe that using ABA is intended to help children behave like their peers, thus making it abusive, wrong, and unethical.

Research, however, shows that this intervention is not unethical. The ultimate goal of this

8 procedure, as pointed out by Morano et al. (2017), is to help children learn coping mechanisms and develop new behaviors that fit societal norms and values.

Despite its potential in improving behavior among autistic children, ABA has not achieved its intended widespread use. The main barrier to universal implementation of this intervention is that until recently, ABA research was predominantly devoted to exploring the impact of individual treatment components on specific behaviors (Cooper, Heron & Heward, 2020). However, self-injurious behavior commonly co-occurs with different behavioral challenges, including aggression towards others and may have numerous maintaining effects.

Additionally, clinical interventions often entail bringing various problems under some degree of control before the problem escalates to unmanageable levels. Introducing the degree of control involves simultaneously implementing several interventions rather than each intervention at a time. Cooper, Heron, and Heward (2020) pointed out that Behavioral interventions, therefore, require clinicians to apply evidence from the literature as a guide in developing effective interventions for individual cases.

Conclusion Self-harm is a common behavior presented by autistic children and people with various psychiatric conditions. Behavioral analysts are not sure of the exact cause of this behavior.

Researchers used various theoretical frameworks to explicate self-injurious behavior and propose the most effective interventions. A crucial framework used to explore various issues related to SIB is developmental psychopathology. This concept proposes that SIB in autism is attributable to traumatic experiences. Other potential causes of SIB in the target population, as highlighted in the research, include a decreased cognitive capacity, communication deficit, abnormal social

9 functioning, and atypical sensory processing. Applied behavior analysis is a key intervention to SIB in the target population. This intervention is pegged on the concept of reinforcement which supports activities that promote positive behavior. Behavioral analysts employ ABA to improve communication, increase confidence and help autistic persons express their feelings instead of using self-injurious actions to attract attention.

10 References Boesch, M. C., Taber-Doughty, T., Wendt, O., & Smalts, S. S. (2015). Using a Behavioral Approach to Decrease SIB in an Adolescent With Severe Autism: A Data-Based Case Study. Education & Treatment of Children (West Virginia University Press), 38(3), 305– 328. https://doi.org/10.1353/etc.2015.0012 Buckmaster, R., McNulty, M., & Guerin, S. (2019). Family factors associated with self‐harm in adults: a systematic review. Journal of Family Therapy, 41(4), 537–558. https://doi.org/10.1111/1467-6427.12232 Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review.

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11 Morano, S., Ruiz, S., Hwang, J., Wertalik, J. L., Moeller, J., Karal, M. A., & Mulloy, A. (2017).

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