Thirty-month demonstration project for treatment of self-injurious behavior in severely retarded individuals.

Eighteen severely and profoundly retarded adolescents were treated in a research and demonstration project within a state institution by behavior modification methods for 30 months. Most showed traits of autism, phobias and persistant vulnerability. Restraints had acquired stimulus control. Programming, an aversive event, evoked SIB as avoidance reaction. Effect of pharmacotropic medication was transitory at best. Combination of several behavior modification techniques obtained complete suppression of SIB in 66.6%, partial in 16.7% and none in 16.7%. Non-aversive behavior modification methods, though slow-acting and time-consuming, produced permanent results in 72.7%. Aversive stimulation by remote controlled ESS suppressed SIB instantaneously and made SIB residents accessible to behavior modification and training. In 43%, durability of extinction was limited, despite concomitant intensive full-day behavior modification programs. Extinction was maintained through booster ESS. In two of seven cases ESS lost its aversive qualities. The use of ESS appears justified when non-aversive treatment modalities have failed and life-threatening situations persist.