A long-term follow-up of treatment for severe self-injury.

One of the shortcomings in the literature is the paucity of long-term follow-up reports of the treatment of self-injury and other destructive behavior, particularly of treatment involving contingent shock. This is a report of a long-term follow-up of treatment for a woman with severe mental retardation and severe self-injurious behavior (SIB) treated initially with the Self-Injurious Behavior Inhibiting System (SIBIS) in brief clinical trials. Programmed generalization and maintenance procedures consisted of treatment throughout all waking hours in all settings as well as during brief sessions. Significant reductions attained in the SIBIS clinical trials generalized to the natural environment and the brief follow-up sessions; however, rates began to climb in the natural environment until a SIBIS pairing procedure could be applied more consistently as a consequence of self-injury. Contingent shock was discontinued after month 30 of follow-up. Overall rates of SIB episodes in the natural environment were reduced from an average of 24.6 per month in the 7 months prior to the SIBIS clinical trials to less than 2 per month during the 72 months of follow-up. Rates in brief treatment sessions remained low during the entire follow-up period. Implications of these results are discussed.