Evaluation of a Treatment Package for Chronic, Stereotypic Hand Mouthing of a Child Diagnosed with Autism

We describe the clinical treatment of repetitive, stereotypic hand mouthing in a 7-year old child with severe developmental delay, conducted in the context of center-based autism service. The client’s history included use of mechanical restraint to prevent tissue damage and infection. Prior antecedent- and reinforcement-based interventions were ineffective. Functional analysis results suggested hand mouthing was maintained by automatic reinforcement. Response interruption and redirection (RIRD) initially did not decrease hand mouthing, but the addition of contingent protective equipment, together with modified RIRD, was followed by reduction to near-zero level, which was maintained following withdrawal of the intervention.

• Repetitive hand mouthing may require treatment due to tissue damage and other health consequences.

• Repetitive hand mouthing is typically maintained in the absence of social contingencies and may be resistant to treatment.

• When reinforcement-based interventions are not sufficient, contingent application of nonrestraining protective equipment may produce lasting reduction in hand mouthing.

• Successful intervention in this case freed the client from mechanical (arm band) restraint and was followed by gains in skill acquisition.