CYCLICAL SELF-INJURIOUS-BEHAVIOR, CONTINGENT WATER MIST TREATMENT, AND THE POSSIBILITY OF RAPID-CYCLING BIPOLAR DISORDER

Cyclical self-injurious behavior (SIB) in the form of self-slapping wa s treated in a 45-year-old, profoundly retarded woman who had a life-l ong history of SIB. Her SIB alternated between high (mean = 8.54 respo nses per min; SD = 6.77 and low (mean = 0.05 responses per min; SD = 0 .20) frequencies every 8 weeks on average. Instances of self-slapping produced water mist treatment paired with a verbal command, ''No hitti ng''. Absence of self-slapping and/or completion of a work task led to a variety of outcomes, including brief back rubs, sips of water, smal l edibles, and praise. Water mist treatment reduced the frequency of S IB within treatment days during high frequency periods, but produced n o reduction across treatment days. Treatment onset was associated with a slight increase in the frequency of SIB during three of the five lo w frequency periods. However, water mist treatment suppressed SIB comp letely in sessions during low frequency periods and the suppression co ntinued across treatment days. Water mist treatment produced no discer nible changes in the length of the high and low frequency periods of S IB.