# A Clinical Trial for Treatment-Resistant Subtypes of Self Injury

> **NIH NIH R01** · HUGO W. MOSER RES INST KENNEDY KRIEGER · 2024 · $333,354

## Abstract

Project Summary/Abstract
At least one quarter of the 18 million persons in the US with intellectual and developmental disabilities engage
in self-injurious behavior (SIB), which can result in injuries, disfigurement, and loss of function (e.g., blindness).
In most cases, SIB is maintained by social reinforcement (e.g., attention). SIB that persists in the absence of
social reinforcement has been referred to as automatically reinforced SIB (ASIB), based on the supposition
that the behavior itself produces some type of biological reinforcement. The current standard of care approach
to treatment for ASIB includes two phases: a Pre-Treatment Assessment (a Competing Stimulus Assessment
to identify stimuli associated with reductions in ASIB), followed by treatment where competing stimuli are
delivered on a noncontingent reinforcement (NCR) schedule. Our NICHD- supported research to date has
identified subtypes of ASIB that vary greatly in terms of their responsiveness to these treatments. Subtypes are
based on results of standardized assessment conditions: Subtype 1 varies inversely with the level of
stimulation across conditions; Subtype 2 is invariant; and Subtype 3 is characterized by self-restraint, a
self-limiting behavior that occurs to avoid ASIB, but also impairs adaptive functioning. Treatments using NCR
with competing stimuli alone are effective in over 82% of cases with Subtype 1, but in only 7% of cases with
Subtype 2 or 3, necessitating restraint or protective equipment to sufficiently reduce ASIB. The identification of
subtypes has revealed the urgent need for more effective interventions for the treatment-resistant subtypes.
Fortunately, our research (R01 HD076653) has also led to several recent discoveries that provide the
conceptual and empirical basis for a new Intensified Approach to treatment targeting the most
treatment-resistant subtypes (Subtype 2 and 3 ASIB). The proposed treatment approach is based on the same
principles as the current Standard of Care Approach (Matching Law and reinforcer competition), but employs
novel methods to more effectively compete with reinforcement maintaining Subtype 2 and 3 ASIB, and to
address self-restraint for Subtype 3. The proposed Intensified Approach to treatment includes three phases: 1)
Pre-Treatment Assessments will identify competing stimuli, tasks, and self-control devices that reduce ASIB; 2)
Intensive Training to strengthen skills needed to fully access available reinforcement, and replace debilitating
self-restraint; and 3) Combination Treatment using NCR to deliver, and differential reinforcement for
engagement with: multiple competing stimuli, competing tasks, and alternative self-control devices (for Subtype
3). Combination Treatment is designed to greatly increase the amount and vary the sources of alternative
reinforcement. Aim 1 is to identify and establish competing stimuli, competing tasks, and self-control devices
(Subtype 3 ASIB). Aim 2 is to employ a randomized crossover de...

## Key facts

- **NIH application ID:** 10806121
- **Project number:** 5R01HD076653-10
- **Recipient organization:** HUGO W. MOSER RES INST KENNEDY KRIEGER
- **Principal Investigator:** LOUIS P. HAGOPIAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $333,354
- **Award type:** 5
- **Project period:** 2013-09-27 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10806121

## Citation

> US National Institutes of Health, RePORTER application 10806121, A Clinical Trial for Treatment-Resistant Subtypes of Self Injury (5R01HD076653-10). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10806121. Licensed CC0.

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