Meta-analysis of single-case treatment effects on self-injurious behavior for individuals with autism and intellectual disabilities

Abstract

Background and aim: Research has demonstrated that a variety of treatments can reduce or eliminate self-injurious behavior (SIB) in individuals with autism and/or intellectual disabilities but evidence suggests that not all treatments are equally effective. Methods: We used multi-level meta-analysis to synthesize the results of 137 single-case design studies on SIB treatment for 245 individuals with autism and/or intellectual disabilities. Analyses compare the effects of various behavioral and medical treatments for SIB and assess associations between treatment effects and participant-and study-level variables. Results: Findings suggest differential reinforcement, punishment, and treatment packages with reinforcement and punishment components resulted in the largest SIB reductions. Conclusions: Results indicate that overall, treatment for SIB is highly effective and that participant and study characteristics do not moderate treatment effects. Implications: Based on results and in line with current practice recommendations, we encourage use of reinforcementbased procedures in all cases of SIB. In the event that reinforcement-only treatments have failed or if SIB poses a serious, immediate threat to the health and well-being of an individual, our results suggest that overcorrection paired with reinforcement may be the most effective as well as less invasive alternative.

Development of Infants With Congenital Zika Syndrome: What Do We Know and What Can We Expect?

“…Self-injurious behaviors (eg, head banging and eye poking) as a result of sensory seeking are common among children with visual and/or auditory impairments and intellectual disability, 39 so these behaviors should be expected and monitored in children with CZS. Children with milder phenotypes may be more likely to have behavioral issues if patterns in CZS mirror other conditions with a spectrum of outcomes.…”

Changing Hitting Chest to be Stroking Chest with Shaping and Differential Reinforcement of Alternative Behavior Method for a child with Autism Spectrum Disorder with Intellectual Impairment

“…In this program, the method used was the DRA method. The DRA method was perceived as the most effective method to decrease SIB due to the implementation of reinforcement-based treatments (Morano, et al 2017). In the application of DRA techniques, behaviors considered problematic are eliminated by exchanging these behaviors for more meaningful alternative behaviors.…”

“…The stroking-chest behavior can be formed through DRA method. The DRA method is the most effective method to decrease SIB because it implements reinforcement-based treatments (Morano, Ruiz, Hwang, Wertalik, Moeller, Karal, & Mulloy. 2017).…”

Using response ratios for meta-analyzing single-case designs with behavioral outcomes

“…Even though it has only recently been proposed for use in the context of single-case research, researchers have begun to apply the LRR in large-scale meta-analyses of SCDs (Common, Lane, Pustejovsky, Johnson, & Johl, 2017;Morano et al, 2017). However, available literature on the LRR is limited to a single, technically-focused article (Pustejovsky, 2015) on how the metric works in the context of a statistical model for systematic direct observation of behavior.…”