Parent-mediated Treatment of Children's Self-injurious Behavior Using Overcorrection

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Abstract
Parents of four children manifesting self-injurious behaviors were trained to deal with the behaviors by using overcorrection procedures. A multiple baseline design was used to assess the effects of treatment. The procedures were found to produce zero or near-zero levels of self-injurious behavior for children who received treatment, and treatment gains seemed to generalize across settings and over time. Follow-up observations up to two and a half years later suggested that the effects were durable ones. Self-injurious behavior has been defined as behavior which produces physical injury to the individual's own body (Tate and Baroff, 1966), or self-directed behavior resulting in pain or physical injury (Bachman, 1972). Common forms have included head-banging, slapping and punching the face, hitting the jaw against the shoulder, biting, pinching or scratching various parts of the body, hair pulling, etc. (Tate, 1972). While the preponderance of clinical observations of these behaviors have involved institutionalized children with diagnoses of autism, schizophrenia, retardation and organic disability (Bachman, 1972), these behaviors have also been reported to occur among small percentages of normal children (Green, 1967). Self-injurious behaviors have historically been resistant to treatment efforts. Tate (1972) reported that prior to the advent of behavior therapy, commonly employed treatments included medication, physical restraints and protective garments. Techniques derived from learning theory have recently been developed and utilized with a greater degree of success. These strategies have been reviewed by Smolev (1971) and have included: 1) extinction of the undesirable behavior (Brener & Lovaas, 1968), 2) suppression of the undesirable behavior using time-out procedures (Wolf, Risley, Johnson, Harris & Allen, 1967; Wolf, Risle & Mees, 1964), 3) establishment of incompatible behaviors using positive reinforcement (Repp & Dietz, 1974; Peterson & Peterson, 1968), and 4) suppression of the undesirable behavior using aversive or noxious stimulation (Bucher & Lovass, 1968; Corte, Wolfe & Locke, 1971; Lovaas & Simmons, 1969). While each of these techniques has been used effectively to treat self-injurious behaviors, certain limitations have also been noted. For example, with extinction, time-out, or reinforcement of incompatible behaviors, a number of self-injurious acts may be committed (permitting pain and possible injury) before the self-injurious behavior is eliminated. Likewise, the therapeutic use of brief noxious stimuli (usually electric shock) has typically resulted in a rapid and durable elimination of self-injury; however, ethical objections have been raised regarding the deliberate administration of pain-producing stimuli with children. Foxx and Azrin (1973) have recently described a procedure termed “overcorrection” which they demonstrated to be an effective, enduring and acceptable means of treating self-stimulatory behaviors. Foxx and Martin (1975) reported that overcorrection procedures have also been used effectively to treat aggressive-disruptive behaviors, scavenging behavior and toileting accidents. The rationale underlying overcorrection has been to require the inappropriately behaving individual to overcorrect the effects of his inappropriate behavior and to actively practice more appropriate forms of behavior. Because these procedures have not involved the administration of physically painful stimuli, they have been considered more appropriate for widespread application (Foxx & Azrin, 1973). Programs to treat children's self-injurious or self-stimulatory behaviors have generally been implemented by the interested investigator or other professionals in well controlled settings. Only after the behaviors have been supressed or eliminated in these settings have parents or caretakers been trained to implement the procedures in other settings (Risley, 1968; Wolf, et al. 1964). Instances in which parents have been trained to treat self-injurious behaviors in the naturalhome setting have been infrequent (Merbaum,1973). The purpose of the following study was to assess the effectiveness of two sets of overcorrection procedures designed to eliminate children's self-injurious head-banging and hand-biting behaviors. The degree to which parents could assume responsibility for implementing treatment procedures was also assessed by conducting all intervention in the child's natural home. Third, participants were contacted up to two and one half years following treatment to assess the long-term durability of changes achieved with treatment.

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