Clinical Psychology of Severe Intellectual Disability
Reading Notes
Prepatory reading for weeks 3-5 Self-injurious behaviour
Chris Oliver (1995) – Self-injurious behaviour in children with learning disabilities: Recent
advancements in assessment and intervention
The onset of self-injury
Association with minor illness e.g. skin conditions, ear infections etc.
Previously existing stereotyped behaviours
The maintenance of self-injury
Reinforcing consequences – sensory or social
Light and colour from eye pressing, scratching to relieve irritation, social contact, escape
from an institution
Reinforcing through aversiveness of self-injury evoked by deprivation of social contact
SIB ceases when social contact given but if no social contact occurs SIB will continue,
SIB is aversive to the adult and the absence of social contact from them will be punished by
the continuance of SIB
Environmental causes
, Disruption in routines
Coercive and authoritarian put high levels of demands on individuals and in turn increase SIB
Low staff: student ratios = less social contact
Individual characteristics
Greater degree of intellectual disability correlates with SIB
Less able to communicate, SIB may serve this function/compensates for an absence of
alternative behaviours
Specific conditions e.g. autism, visual and physical disabilities and specific syndromes e.g.
Lesch-Nyhan and Gilles de la Tourette are related to SIB
May be due to lack of capacity for adaptive behaviour (physical disability) or increased
likelihood of stereotyped behaviours in autism
As well as transient states that may increase SIB such as menstrual cycle, hunger, fatigue,
illness, depression, chronic pain
Response efficiency in SIB
Horner and Day (1991)
Response efficiency of self-injury is determined by cost of physical effort involved in
responding (pain also included as cost), gain from reinforcement, delay in presentation of
reinforcement
If an alternative response is functionally equivalent but less efficient in any of these
parameters, SIB will occur
The assessment of the determinants of self-injury
Data collected by natural observations, questionnaires, interviews, charting, experimental
manipulation
Motivation Assessment Scale (MAS) questionnaire used in clinical decision making, but has
been criticised for not being empirical (tries to distinguish between socially mediated stimuli,
may mask a general principle) and reliability has been questioned
Interventions for self-injury
Functional equivalence training
Seeks to replace SIB with alternative behaviour
E.g. simple signing, using tokens but form is generally irrelevant, it is the impact that is
critical
May lead to extinction of target behaviour, reinforcement of incompatible behaviours,
replacement behaviour is evoked when the establishing operation which previously evoked
the SIB is operative means that the behaviour comes under the same stimulus control as
self-injury and individual controls the schedule of reinforcement
Functional equivalence training may not always work – less efficient as it is less aversive than
SIB, alternative response may require less effort etc.
Environmental factors may lower the efficiency e.g. staff ratios
Studies have found that presentation of the ‘wrong’ contingency may increase challenging
behaviour (Durand et al 1989)
The use of differential reinforcement of other behaviours as intervention
Extinction is the most influential component when compared to the reinforcement process
Reading Notes
Prepatory reading for weeks 3-5 Self-injurious behaviour
Chris Oliver (1995) – Self-injurious behaviour in children with learning disabilities: Recent
advancements in assessment and intervention
The onset of self-injury
Association with minor illness e.g. skin conditions, ear infections etc.
Previously existing stereotyped behaviours
The maintenance of self-injury
Reinforcing consequences – sensory or social
Light and colour from eye pressing, scratching to relieve irritation, social contact, escape
from an institution
Reinforcing through aversiveness of self-injury evoked by deprivation of social contact
SIB ceases when social contact given but if no social contact occurs SIB will continue,
SIB is aversive to the adult and the absence of social contact from them will be punished by
the continuance of SIB
Environmental causes
, Disruption in routines
Coercive and authoritarian put high levels of demands on individuals and in turn increase SIB
Low staff: student ratios = less social contact
Individual characteristics
Greater degree of intellectual disability correlates with SIB
Less able to communicate, SIB may serve this function/compensates for an absence of
alternative behaviours
Specific conditions e.g. autism, visual and physical disabilities and specific syndromes e.g.
Lesch-Nyhan and Gilles de la Tourette are related to SIB
May be due to lack of capacity for adaptive behaviour (physical disability) or increased
likelihood of stereotyped behaviours in autism
As well as transient states that may increase SIB such as menstrual cycle, hunger, fatigue,
illness, depression, chronic pain
Response efficiency in SIB
Horner and Day (1991)
Response efficiency of self-injury is determined by cost of physical effort involved in
responding (pain also included as cost), gain from reinforcement, delay in presentation of
reinforcement
If an alternative response is functionally equivalent but less efficient in any of these
parameters, SIB will occur
The assessment of the determinants of self-injury
Data collected by natural observations, questionnaires, interviews, charting, experimental
manipulation
Motivation Assessment Scale (MAS) questionnaire used in clinical decision making, but has
been criticised for not being empirical (tries to distinguish between socially mediated stimuli,
may mask a general principle) and reliability has been questioned
Interventions for self-injury
Functional equivalence training
Seeks to replace SIB with alternative behaviour
E.g. simple signing, using tokens but form is generally irrelevant, it is the impact that is
critical
May lead to extinction of target behaviour, reinforcement of incompatible behaviours,
replacement behaviour is evoked when the establishing operation which previously evoked
the SIB is operative means that the behaviour comes under the same stimulus control as
self-injury and individual controls the schedule of reinforcement
Functional equivalence training may not always work – less efficient as it is less aversive than
SIB, alternative response may require less effort etc.
Environmental factors may lower the efficiency e.g. staff ratios
Studies have found that presentation of the ‘wrong’ contingency may increase challenging
behaviour (Durand et al 1989)
The use of differential reinforcement of other behaviours as intervention
Extinction is the most influential component when compared to the reinforcement process
