Behavioral and naltrexone treatment of self-injurious behavior

Abstract

Severe self-injurious behavior in a boy with severe mental retardation and autistic disorder was successfully treated with a behavioral treatment package following a trial of naltrexone to reduce self-injurious behavior. The subject was a 7-year-old boy who was hospitalized for self-injurious behavior, aggression, and a reported increased irritability. During baseline assessment, the subject was physically and verbally interrupted and redirected whenever he engaged in self-injurious behavior. During the first treatment phase, pediatric “no-no” splints were applied and systematic splint fading began. In addition, differential reinforcement of other behaviors (DRO) and a brief hand restraint were implemented. In the second treatment phase, naltrexone was administered with the continued use of systematic point fading, DRO and brief hand restraint. The third treatment phase consisted of a placebo trial and the same behavioral treatment. In the final phase, restraint fading continued and reinforcement was faded to a variable interval (VI)-3 minute schedule, as well as the use of brief hand restraint. This treatment package was effective in reducing this boy’s severe self-injurious behavior to zero upon discharge from the hospital. Follow-up data from the school indicated continued success with the use of the brief contingent hand restraint as well as reinforcement delivered on a VI-3 min schedule.