JOURNAL OF APPLIED BEHAVIOR ANALYSIS 1997, 30, 165–167 NUMBER 1 (SPRING 1997)

FUNCTIONAL ANALYSIS OF EPISODIC

SELF-INJURY CORRELATED WITH
RECURRENT OTITIS MEDIA
MARK F. O’REILLY
UNIVERSITY COLLEGE, DUBLIN

A functional analysis examined the consequences that maintained episodic self-injury and
the relationship between those consequences and otitis media for a child with moderate
developmental disabilities. Results indicated that self-injury occurred only during periods
of otitis media. Otitis media may have served as an establishing operation related to
escape from ambient noise.
DESCRIPTORS: episodic self-injury, functional analysis, establishing operations, bi-
ological setting events, otitis media

Occasionally, functional analyses fail to METHOD

identify maintaining contingencies because
Participant, Setting, and Target Behavior
aberrant behavior is episodic in nature
(O’Reilly, 1996). Such episodic aberrant be- Mary, a 26-month-old girl with moderate
havior may be influenced by extraneous vari- developmental disabilities, participated in
ables, such as establishing operations, that the study. She had also been diagnosed with
are not directly manipulated in the analogue Williams syndrome, a condition that is as-
environment. Recent research has demon- sociated with hypersensitivity to sound and
strated that biological conditions such as recurrent otitis media. Mary was placed on
sleep deprivation and allergy symptoms may antibiotic regimens whenever otitis media
function as establishing operations and may was diagnosed during the study. Her mother
influence performance under controlled an- was trained to implement the analogue as-
sessment conditions at home while the ex-
alogue conditions (Kennedy & Meyer, 1996;
perimenter (author) and a graduate student
O’Reilly, 1995). Other biological condi-
in psychology (reliability observer) collected
tions, such as otitis media, have also been
observational data. Mary’s SIB consisted of
hypothesized to influence the occurrence of
back banging and ear poking. These behav-
aberrant behavior (Carr & Smith, 1995; Ca- iors typically occurred simultaneously. Struc-
taldo & Harris, 1982). The purpose of this tured interviews with Mary’s mother and
study was to examine the potential of ana- general medical practitioner indicated that
logue techniques to assess the function of SIB occurred at high frequencies for approx-
episodic self-injurious behavior (SIB) and imately 3 to10 days per month (usually in
the relationship between the presence of self- continuous bouts of 2 to 3 days). Hypoth-
injury and otitis media. eses derived from the interviews regarding
the occurrence of self-injury included (a) so-
This study was supported by a research grant from
cial attention during episodes of otitis me-
the Faculty of Arts, University College Dublin. dia, (b) escape from demands during epi-
All correspondence can be sent to Mark O’Reilly, sodes of otitis media, (c) sensory reduction
Intellectual Disability Research and Training Unit, during episodes of otitis media, and (d) sen-
Department of Psychology, University College Dublin,
Belfield, Dublin 4, Ireland (E-mail: moreilly@macolla sory stimulation during episodes of otitis
mh.ucd.ie). media. (Complete definitions of target be-

165
166 MARK F. O’REILLY

haviors and interview protocol are available (e.g., sitting to standing, standing indepen-
from the author.) dently). Mary was verbally encouraged
throughout the routine and praised for cor-
Procedures and Design rect performance. Instruction was discontin-
Six assessment conditions were presented ued for a minimum of 10 s when self-injury
in a multielement format to test the hypoth- occurred and was immediately reinstated fol-
eses. The assessment was conducted over a lowing this delay or when self-injury
2-month period to obtain a sufficient num- stopped.
ber of days (7 days total) to conduct the Alone. Mary was placed alone in the room
functional analysis when otitis media was di- with no toys. This condition was used to test
agnosed. When Mary exhibited self-injury, whether self-injury served a self-stimulatory
her mother was instructed to bring her to function.
the general practitioner for a medical ex- Radio on. This condition mirrored the
amination. If otitis media was diagnosed, alone condition with the exception that a
then a functional analysis was conducted radio was played at high volume while Mary
that day. Functional analysis probes were was alone in the room. Radio on was used
also conducted on 3 days when otitis media to test whether self-injury served a sensory
was not present to examine performance un- reduction function.
der analogue assessment in the absence of Escape high sensory. This condition was in-
this medical condition. Mary received a cluded in the final phase of the functional
medical examination for the presence of oti- analysis based on the findings of the earlier
tis media on each day that the functional phases of the assessment. The escape-high-
analysis was conducted. Analogue sessions sensory condition differed from the radio-on
were 10 min long, with a 5-min break be- condition in that the radio (played at same
tween sessions. Self-injury was recorded us- volume as in the radio-on condition) was
ing a 10-s partial-interval procedure. Mean turned off contingent on self-injury for 10 s
agreement on occurrence of self-injury, as- or until self-injury stopped.
sessed during 26% of sessions, was 94%. Play. The play condition mirrored the at-
With the exception of the demand condi- tention condition, with the exception that
tion, all assessments were conducted in the the mother maintained a closer proximity
family kitchen with Mary seated in a high and played with Mary while verbally inter-
chair or reclined in a rock-a-bye chair. acting with her approximately every 5 s.
Social attention. Mary’s mother was pres-
ent in the room with Mary while the exper-
imenter unobtrusively recorded self-injury RESULTS AND DISCUSSION
outside the room (observations were con- Figure 1 shows that functional analysis
ducted in this manner throughout the probes in the absence of otitis media yielded
study). Various toys were available but no no self-injury (Phases 1, 3, and 5). Phase 2
particular tasks were provided. The mother (with otitis media) yielded undifferentiated
verbally interacted with Mary for approxi- results. Low responding during the alone
mately 10 s contingent on the occurrence of condition in Phase 2 (range, 0% to 8%) sug-
self-injury. gested that self-injury might be maintained
Escape from demands. The escape condi- by escape from ambient noises. Phase 4
tion was conducted on a mat in the living (with otitis media) consisted of an extended
room. The mother physically assisted Mary assessment of the radio-on condition that
through a series of physiotherapy routines yielded persistent self-injury (M 5 34.5%;
 EPISODIC SELF-INJURY 167

Figure 1. Percentage of intervals of self-injury under alone, attention, play, demand, and radio-on conditions
in the absence of otitis media (Phases 1, 3, and 5); under alone, attention, play, demand, and radio-on
conditions with otitis media (Phase 2); under alone and radio-on conditions with otitis media (Phase 4); and
under alone and escape-high-sensory conditions with otitis media (Phase 6).

range, 24% to 44%). This confirmed that termed by Carr and Smith (1995), a biolog-
the behavior occurred at high rates when ical setting event related to escape from am-
loud noise was introduced to the environ- bient noises.
ment. A further assessment condition was
included in the final phase of the analogue
analysis with otitis media and demonstrated REFERENCES
that self-injury also may have served a sen- Carr, E. G., & Smith, C. E. (1995). Biological setting
sory escape function (M 5 36.5%; range, events for self-injury. Mental Retardation and De-
16% to 62%). Conclusions regarding a sen- velopmental Disabilities Research Reviews, 1, 94–
98.
sory escape function are tentative because Cataldo, M. F., & Harris, J. (1982). The biological
this condition was not examined when otitis basis of self-injury in the mentally retarded. Anal-
media was absent. In addition, failure to rep- ysis and Intervention in Developmental Disabilities,
licate the social attention, escape from de- 7, 21–39.
Kennedy, C. H., & Meyer, K. A. (1996). Sleep de-
mand, and play conditions in the presence privation, allergy symptoms, and negatively rein-
of otitis media limits the conclusions that forced problem behavior. Journal of Applied Be-
can be drawn regarding the maintaining havior Analysis, 29, 133–135.
O’Reilly, M. F. (1995). Functional analysis and treat-
contingencies. ment of escape-maintained aggression correlated
These limitations notwithstanding, this with sleep deprivation. Journal of Applied Behavior
study extends the use of analogue analysis Analysis, 28, 225–226.
techniques to the functional assessment of O’Reilly, M. F. (1996). Assessment and treatment of
episodic self-injury: A case study. Research in De-
episodic self-injury. The study also demon- velopmental Disabilities, 17, 349–361.
strated a conditional functional relationship
between the presence of otitis media and Received April 22, 1996
Initial editorial decision June 5, 1996
self-injury. Thus, otitis media may have Final acceptance September 30, 1996
served as an establishing operation or, as Action Editor, Patrick C. Friman