CONTENT WARNING: The contents of this document cover self-injurious behavior which include self-harm and suicidal ideation / attempts. If you or a loved one are struggling with your mental health, please reach out to a professional and seek appropriate interventions and support. Below are some resources that will be helpful if you or a loved one are struggling with mental health.

The National Suicide Prevention Hotline: Call 1-800-273-TALK (8255)

Ayuda En Español: Llame a 1-888-628-9454

Crisis Text Line: Text HELLO to 741741

Lifeline Crisis Chat: Chat online

Call 911 or go to the nearest emergency room

Suicide Prevention Resources for Parents, Educators & Professionals | Columbia University | Child Psychiatry

Self-injurious behavior may stem from a child’s struggle with communication (for example, a struggle to express emotions such as anger or frustration), desire to get a parent’s attention, need for escape / avoidance from a situation, or need for sensory stimulation. However, these are not the only reasons that your child may engage in self-injurious behavior. In some cases, your child may engage in self-injurious and / or risky behaviors in order to fit in with their peers. For example, they may engage in ongoing viral social-media trends (such as social-media performances where users eat a detergent pod or jump out of windows) to appear more in tune with their peers and friends.

The tendency to engage in self-injurious behavior can occur in almost half of children on the autism spectrum (The Prevalence of Self-injurious Behaviour in Autism: A Meta-analytic Study). Self-injurious behavior occurs at different frequencies and with different levels of intensity in terms of the behavior itself and the injury or injuries sustained from the behavior. These behaviors can manifest in many forms, such as the child banging their fists against their own head, biting, scratching, pulling hair, and other behaviors. To help reduce the risk of physical injuries resulting from self-injurious behavior, it is important to take steps to reduce self-injurious behavior by replacing it with different behavior(s) or introducing incompatible behaviors (e.g., using a fidget toy or play dough to keep hands busy to prevent scratching self, playing a game with buttons that you have to press to keep hands away from picking at skin or biting nails, etc.). 

When working with your child to reduce self-injurious behaviors, it is important to remember to validate your child’s emotions. Self-injurious behaviors often arise in response to your child struggling to communicate with you. By fostering an environment in which  your child feels comfortable communicating with you, you can help your child gain the  confidence they  need to help them initiate communication with you. It is particularly important to exercise patience and kindness with your child as they work on learning to communicate their emotions and thoughts with you.

Should your child’s self-injurious behavior become more intense, such as increasing in frequency or becoming more dangerous, do not hesitate to reach out to a behavior specialist for assistance.

IMPORTANT! SELF-INJURIOUS BEHAVIOR DUE TO PHYSICAL AILMENT

Self-injurious behaviors are often a way of communicating, but  they are not always attempts at communication. Sometimes self-injurious behavior may have a basis in a physical condition / ailment. For example, your child may be biting themself or slapping their cheeks due to tooth pain. However, biting may not only be indicative of tooth pain; it could be a way to distract from another source of pain, such as abdominal pain. Self-injurious behavior could also be the result of a mental health comorbidity, such as anxiety or depression. It is a good idea to have an appointment with a doctor or other appropriate healthcare provider or specialist to rule out other causes of self-injurious behavior if you think there is another reason for your child’s behavior aside from attempts at communication.

IMPORTANT! SELF-INJURIOUS BEHAVIOR DUE TO SUICIDAL IDEATION / ATTEMPTS

CONTENT WARNING: The following  section covers suicidal ideation / attempts. If you or a loved one are struggling with your mental health, please reach out to a professional and seek appropriate interventions and support. Below are some resources that will be helpful if you or a loved one are struggling with mental health.

The National Suicide Prevention Hotline: Call 1-800-273-TALK (8255)

Ayuda En Español: Llame a 1-888-628-9454

Crisis Text Line: Text HELLO to 741741

Lifeline Crisis Chat: Chat online

Call 911 or go to the nearest emergency room

Suicide Prevention Resources for Parents, Educators & Professionals | Columbia University | Child Psychiatry

Should your child mention or allude to suicide, suicidal ideation, or planning to attempt suicide, you must take them seriously. While maintaining a calm expression and demeanor, sit down with your child and listen to them talk without interrupting them. It is recommended that you take notes as you listen to your child. If your child tells you that they have a plan to attempt suicide, once you finish listening to them, your first action should be removing the immediate threat, whether it is a gun, pills, knives, etc. If you hide your gun in a different place (rather than removing it from your home) in an effort to prevent your child from accessing it, it is likely that your child actually knows where the new hiding place is. In fact, 75% of children know where their parents hide / store their gun(s) (Gun Safety nationwidechildrens.org). If you wish to continue storing your firearm in your living space, it is recommended that you store the gun and ammunition in locked boxes in separate locations and keep the codes or keys hidden from your child. However, for your child’s safety, if they have expressed intent to kill themself with a gun, it is best to completely remove all access to the gun by removing it from the house. For pills and knives, it is recommended to remove them from the house completely, handing them off to a close friend, neighbor, or family member.

If the threat to your child’s life is urgent, you should either take your child to your local  emergency room or call your child’s primary care provider and get an appointment that day for your child to be seen. You should then begin building a support team for your child that includes a psychiatrist, a psychologist, their primary care provider, etc. If your child is not already diagnosed with depression, that may be something that you and the team decide to investigate.

Below are some resources that will be helpful if you or a loved one are struggling with mental health.

The National Suicide Prevention Hotline: Call 1-800-273-TALK (8255)

Ayuda En Español: Llame a 1-888-628-9454

Crisis Text Line: Text HELLO to 741741

Lifeline Crisis Chat: Chat online

Call 911 or go to the nearest emergency room

Suicide Prevention Resources for Parents, Educators & Professionals | Columbia University | Child Psychiatry

The following strategies may help your child decrease self-injurious behavior:

• Validate your child’s feelings. While working with your child to reduce self-injurious behavior, make sure that you are validating the emotions that they are feeling. It may be tempting to immediately jump to introducing a replacement behavior, but validating your child’s feelings is an integral part of the process of reducing self-injurious behaviors. By validating your child’s feelings, you show them that you are supportive of them and you are there to listen, especially if they are struggling. Providing your child with a sense of support and comfort will help the process.
• Assess the reason behind self-injurious behaviors. A Functional Behavior Assessment / Analysis will help you determine the antecedent or stimulus (e.g., the trigger) for the self-injurious behavior. The first step to helping your child reduce self-injurious behaviors is to understand what leads to the behavior. Take notes on the location and environment of the self-injurious behavior, the events that led up to the self-injurious behavior, and what occurred both during and after the behavior. Doing a Functional Behavior Assessment / Analysis will help you determine the reason behind the behavior.
• Monitor the environment. Is there a specific situation or environment where your child consistently displays self-injurious behavior, for example, a crowded public event? If so, reduce your child’s exposure to this trigger. However, do not expose your child to a known trigger and immediately remove your child when your child begins to injure themselves, as this may unintentionally reinforce or encourage your child’s self-injurious behavior (see more on this below).
• Help your child find appropriate ways to communicate. Self-injurious behavior often stems from struggles with communication. Your child may struggle to communicate their thoughts or feelings, such as anger surrounding a situation they perceive as unfair (e.g., another child cutting the line for lunch), discomfort with an unfamiliar stimulus, or frustration from a situation. It is important to help your child find a way to communicate with you and people around them. You can work with your child to find the appropriate language to communicate with you and others verbally, introduce Picture Exchange Communication System® (PECS®), or use a text-to-speech device. 
• Introduce an incompatible behavior. One way to reduce self-injurious behavior is to introduce “incompatible behaviors.” An incompatible behavior is something that interferes with the self-injurious behavior and makes it difficult or impossible for your child to harm themself. For example, if your child’s self-injurious behavior is pulling on their hair, you can provide them with clay or Play-Doh to occupy their hands, therefore they are not able to pull on their hair.
• Avoid unintentional reinforcement of self-injurious behaviors. A parent or caregiver may have a knee-jerk reaction to take whatever immediate steps they feel are necessary to stop a child from injuring themselves by, for example, providing their child with a preferred item. It is important that you do not unintentionally encourage your child to engage in self-injurious behavior by providing your child with a preferred item, as they will learn that harming themselves will result in a reward. For example, if your child is scratching their skin and you immediately provide them with their tablet to play a favorite game as a distraction, you may be teaching your child that scratching gets rewarded with something enjoyable. If you are introducing an incompatible behavior, you will want to provide the item before the self-injurious behavior occurs, not as a result of the behavior occurring. 
• Provide replacement tools. If you determine that your child is engaging in self-injurious behavior due to sensory issues, you can introduce a replacement tool. For example, if your child is biting themself, you can provide something else for them to chew on, such as gum or a mouthing-safe toy. If the replacement tool you’re providing is a treat, such as gum or another candy, remember to provide the replacement tool before the behavior, not after the behavior, so as to avoid reinforcing the self-injurious behavior. 
• Remove or alter triggers. In some cases, it is not possible to provide an alternative behavior or incompatible behavior. When that happens, it is important to remove or alter the things that trigger your child’s self-injurious behavior. For example, if your child’s self-injurious behavior is triggered by unpredictability, then you can work with them to become familiar with unfamiliar scenarios through watching videos and / or reading social stories. However, if the trigger is frustration with something, such as struggling to complete an academic assignment, you will need to alter the situation. This can be done through, for example, providing your child with more help or making the math assignment easier. Altering the difficulty of school assignments may not be possible on your own, so you may need to seek outside resources, for example, through communicating with your child’s teacher or academic advisor.
• Discuss appropriate activities to do with friends. If you suspect that your child is engaging in self-injurious behavior in order to fit in with their peers (for example, engaging with viral social-media performances and / or stunts), have a conversation with your child about what are considered safe and healthy activities to do with friends. If you believe your child is being bullied or coerced into self-injurious behaviors, reach out to the appropriate professionals. Important: make sure to remind your child that speaking to you about their feelings and experiences is safe. 
• Additional Resources:

For the parent:

Intervention Strategies for Self-Injurious Behaviors (thewatsoninstitute.org)

Self Injury in Autism: Causes and Interventions - Autism Research Institute

How to Use Replacement Behaviors - How to ABA

Self-Injurious Behaviors and How ABA Therapy Can Help - ABA Therapy Services in Chicago, Peoria, and Normal | GBC Autism Services

Decreasing Self-Injurious Behavior During Chores / Replacing with “Asking for Help”

A-B-Cs Groundwork: Identify and consider the following:

1. The interfering behavior that should be decreased and concurrently replaced with an acceptable behavior. For example, if your child hurts themself (self-injurious behavior), their self-injurious behavior should be decreased / replaced with an acceptable behavior (e.g., asking for help).
2. The environment or setting in which the interfering behavior occurs / is triggered, if relevant. For example, your child hurts themself when your child is tasked with cleaning the bathroom.
3. Any antecedent or other stimulus (e.g., a trigger) that causes your child to exhibit the interfering behavior, if relevant. For example, your child hurts themself when they feel overwhelmed by their chores when tasked with cleaning the bathroom.
4. The function of your child’s interfering behavior. For example, your child hurts themself in order to express frustration with their chores and escape the chores when tasked with cleaning the bathroom.
5. The skill that you would like your child to learn in order to decrease or replace the interfering behavior. For example, you would like your child to ask for help instead of hurting themself.
6. How you might simulate the environment and / or stimulus which results in your child displaying the interfering behavior, in order to work with your child towards decreasing / replacing the interfering behavior. For example, if you would like your child to ask for help instead of hurting themself when overwhelmed when cleaning the bathroom, consider simulating a modified / tolerable version of cleaning the bathroom by breaking down the task into smaller parts, such as only cleaning the sink and / or only cleaning the floor, as applicable. 
7. Optional: Model for or explain to your child the desired behavior change. For example, modeling or explaining the acquisition of the skill of asking for help with the bathroom when tasked with cleaning it in order to replace self-injurious behavior could employ the following strategies:

•      --->      Communicate to your child that when they are overwhelmed by their chores, they should ask for help instead of hurting themself. 

•      --->      Use whatever communication strategy works best for your child, and role-play asking for help. You can simulate what a typical dirty sink would look like when the child is tasked with chores, then model or explain asking for help using your child’s preferred method of communication, followed by immediately helping your child clean the sink after asking for help. This will allow your child to observe how asking for help causes the feeling of being overwhelmed by the chore of cleaning the sink to go away.

•      --->      Provide your child with whatever suitable means they need to communicate asking for help.

“Asking for Help”: Teach this skill to replace Self-Injurious Behavior.

• Step 1: Decide what skill acquisition goal or target you would like your child to practice for replacing the interfering behavior. For example, you can choose the skill acquisition goal of asking for help for replacing self-injurious behavior. The task analysis for the skill acquisition target of asking for help with chores could be as follows:

•      --->      Simulate a modified / tolerable version of bathroom chores by breaking it down into tolerable sections, such as only cleaning the sink.

•      --->      Assign your child their chores for the bathroom, broken down into a tolerable section. For example, only ask your child to clean the sink.

•      --->      Your child should ask for help when cleaning their assigned part of the bathroom, i.e., when the sink bothers them.

•      --->      As soon as your child asks for help, provide help instantaneously.
  Note: As your child consistently displays the replacement behavior of asking for help with chores, slowly increase the time between when your child makes the request and when you provide help in small intervals (1 second, 2 seconds, 5 seconds, etc.) This will help your child learn to wait in instances when you cannot provide help immediately.

•      --->      Provide a great deal of verbal praise after helping your child. Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For interfering behavior replacement goals, the removal of the antecedent or stimulus or providing what your child asked for is the reward and should be provided as instantaneously as possible. 

• Step 2: An initial / specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as a picture of a bathroom sink, or a verbal SD (“Time to practice asking for help with chores in the bathroom!” or “Let’s practice asking for help while doing chores in the bathroom!”).
• Step 3: Collect baseline level data for the skill acquisition target (i.e., asking for help with chores in the bathroom) by providing the SD from Step 2 and allowing your child to attempt their part independently. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Note that this baseline collection data step is for the skill acquisition target, and baseline level data for the interfering behavior may already be present in your child’s treatment plan.
• Step 4: To begin the trial to monitor progress towards meeting the skill acquisition target (i.e., asking for help with chores in the bathroom), provide the SD from Step 2, follow the task analysis from Step 1, and allow your child to attempt their part independently. When your child is successful, instantaneously grant their request, for example, instantaneously help them with cleaning the sink. You can then, if appropriate, provide verbal praise for your child, such as saying, “Good job at asking for help!” If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to ask for help with chores in the bathroom, for example as suggested immediately above under Item g in A-B-Cs Groundwork). Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For these goals, the removal of the antecedent or stimulus or providing what your child has asked for is the reward and should be provided instantaneously. 
• Step 5: Collect data on how your child makes progress on the skill acquisition target of asking for help with chores in the bathroom. For example, track progress by counting how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Alternatively, count how many times your child is unable to complete their part of the task analysis independently (i.e., unsuccessful attempts).
• Step 6: Collect data on how your child makes progress on decreasing self-injurious behavior. For example, count the number of instances your child hurts themself while doing chores instead of asking for help with chores over a certain period of time (e.g., a session, a certain number of sessions, etc.). Alternatively, count the number of instances your child hurts themself when doing chores over a certain time period (e.g., 1 month, 3 months, etc.).

Decreasing Self-Injurious Behavior When in a Place With Lots of Smells / Replacing with “Asking for Break”

A-B-Cs Groundwork: Identify and consider the following:

1. The interfering behavior that should be decreased and concurrently replaced with an acceptable behavior. For example, if your child hurts themself (self-injurious behavior), their self-injurious behavior should be decreased / replaced with an acceptable behavior (e.g., asking for a break).
2. The environment or setting in which the interfering behavior occurs / is triggered, if relevant. For example, your child hurts themself when they are  walking through an area with a lot of smells, like a perfume section in a department store.
3. Any antecedent or other stimulus (e.g., a trigger) that causes your child to exhibit the interfering behavior, if relevant. For example, your child hurts themself when they feel overwhelmed by the amount of strong smells in the air.
4. The function of your child’s interfering behavior. For example, your child hurts themself in order to express that they are overwhelmed by the amount of strong smells in the air.
5. The skill that you would like your child to learn in order to decrease or replace the interfering behavior. For example, you would like your child to ask for a break instead of hurting themself.
6. How you might simulate the environment and / or stimulus which results in your child displaying the interfering behavior, in order to work with your child towards decreasing / replacing the interfering behavior. For example, if you would like your child to ask for help instead of hurting themself when overwhelmed by the amount of strong smells in the air, consider simulating a modified / tolerable version of a perfume section in a department store by using one perfume / scent instead of many, and placing a cloth sprayed with very little perfume in the room, as applicable. You can start with one piece of cloth and gradually increase the number as needed so as to not immediately overwhelm your child. 
7. Optional: Model for or explain to your child the desired behavior change. For example, modeling or explaining the acquisition of the skill of asking for a break within the perfume section of a department store in order to replace self-injurious behavior could employ the following strategies:

•      --->      Communicate to your child that when they are overwhelmed by the smells in the perfume section of a department store, they should ask for a break instead of hurting themself. 

•      --->      Use whatever communication strategy works best for your child, and role-play asking for help. You can simulate a perfume section in a department store, then model or explain asking for help using your child’s preferred method of communication, followed by immediately removing the source of the smell after asking for a break. This will allow your child to observe how asking for a break causes the feeling of being overwhelmed by the scents of a perfume section in a department store to go away.

•      --->      Provide your child with whatever suitable means they need to communicate asking for a break.

“Asking for a Break”: Teach this skill to replace Self-Injurious Behavior.

• Step 1: Decide what skill acquisition goal or target you would like your child to practice for replacing the interfering behavior. For example, you can choose the skill acquisition goal of asking for a break for replacing self-injurious behavior. The task analysis for the skill acquisition target of asking for a break from the perfume section of a department store could be as follows:

•      --->      Simulate a modified / tolerable version of the perfume section of a department store by spraying one cloth with perfume and putting it in the room. 

•      --->      Your child should ask for a break when the scent of the perfume bothers them.

•      --->      As soon as your child asks for a break, eliminate the sources of perfume smells instantaneously.
  Note: As your child consistently displays the replacement behavior of asking for a break, slowly increase the time between when your child makes the request and when you eliminate the sources of perfume smells in small intervals (1 second, 2 seconds, 5 seconds, etc.) This will help your child learn to wait in instances when you cannot eliminate the sources of perfume smells immediately.

•      --->      Provide a great deal of verbal praise after removing the sources of the smells. Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For interfering behavior replacement goals, the removal of the antecedent or stimulus or providing what your child asked for is the reward and should be provided as instantaneously as possible. 

• Step 2: An initial / specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as a picture of perfume bottles, or a verbal SD (“Time to practice asking for a break from too many smells!” or “Let’s practice asking for a break when there are too many perfume smells!”).
• Step 3: Collect baseline level data for the skill acquisition target (e.g., asking for a break from the perfume section of a department store) by providing the SD from Step 2 and allowing your child to attempt their part independently. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Note that this baseline collection data step is for the skill acquisition target, and baseline level data for the interfering behavior may already be present in your child’s treatment plan.
• Step 4: To begin the trial to monitor progress towards meeting the skill acquisition target (e.g., asking for a break from the perfume section of a department store), provide the SD from Step 2, follow the task analysis from Step 1, and allow your child to attempt their part independently. When your child is successful, instantaneously grant their request, for example, instantaneously remove the sources of the perfume smells by moving the perfumed cloth to another room. You can then, if appropriate, provide verbal praise for your child, such as saying, “Good job at asking for a break!” If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to ask for a break when overwhelmed by smells in a perfume section of a department store, for example as suggested immediately above under Item g in A-B-Cs Groundwork). Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For these goals, the removal of the antecedent or stimulus or providing what your child has asked for is the reward and should be provided instantaneously. 
• Step 5: Collect data on how your child makes progress on the skill acquisition target of asking for a break from the perfume section of a department store. For example, track progress by counting how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Alternatively, count how many times your child is unable to complete their part of the task analysis independently (i.e., unsuccessful attempts).
• Step 6: Collect data on how your child makes progress on decreasing self-injurious behavior. For example, count the number of instances your child hurts themself while in the perfume section of a department store instead of asking for a break over a certain period of time (e.g., a session, a certain number of sessions, etc.). Alternatively, count the number of instances your child hurts themself when in the perfume section of a department store over a certain time period (e.g., 1 month, 3 months, etc.).

Decreasing Self-Injurious Behavior When Wanting Attention While Parent is Reading a Book / Replacing with “Asking for Attention”

A-B-Cs Groundwork: Identify and consider the following:

1. The interfering behavior that should be decreased and concurrently replaced with an acceptable behavior. For example, if your child hurts themself (self-injurious behavior), their self-injurious behavior should be decreased / replaced with an acceptable behavior (e.g., asking for attention).
2. The environment or setting in which the interfering behavior occurs / is triggered, if relevant. For example, your child hurts themself when your child wants your (the parent’s) attention when you are reading a book.
3. Any antecedent or other stimulus (e.g., a trigger) that causes your child to exhibit the interfering behavior, if relevant. For example, your child hurts themself when they want your (the parent’s) attention but you are reading a book.
4. The function of your child’s interfering behavior. For example, your child hurts themself in order to communicate that they want your attention when you are preoccupied.
5. The skill that you would like your child to learn in order to decrease or replace the interfering behavior. For example, you would like your child to ask for attention instead of hurting themself.
6. How you might simulate the environment and / or stimulus which results in your child displaying the interfering behavior, in order to work with your child towards decreasing / replacing the interfering behavior. For example, if you would like your child to ask for attention instead of hurting themself when they want your (the parent’s) attention but you are reading a book, consider simulating a modified / tolerable version of not paying attention to your child by pretending to read a book while in the room with your child, as applicable. 
7. Optional: Model for or explain to your child the desired behavior change. For example, modeling or explaining the acquisition of the skill of asking for attention when your child wants your (the parent’s) attention but you are reading a book in order to replace self-injurious behavior could employ the following strategies:

•      --->      Communicate to your child that when they want attention, they should ask for attention instead of hurting themself. 

•      --->      Use whatever communication strategy works best for your child, and role-play asking for attention. You can pretend to read a book, then model or explain asking for attention using your child’s preferred method of communication, followed by immediately putting the book down and looking at your child and answering them after asking for attention. This will allow your child to observe how asking for attention causes your inattention  to go away.

•      --->      Provide your child with whatever suitable means they need to communicate asking for attention.

“Asking for Attention”: Teach this skill to replace Self-Injurious Behavior.

• Step 1: Decide what skill acquisition goal or target you would like your child to practice for replacing the interfering behavior. For example, you can choose the skill acquisition goal of asking for attention for replacing self-injurious behavior. The task analysis for the skill acquisition target of asking for attention when a parent is reading a book could be as follows:

•      --->      Simulate a modified / tolerable version of a parent being occupied by sitting away from your child  and doing a different task, such as reading a book, as applicable.

•      --->      Allow your child to begin playing in the same room as you, and begin to read your book in another area of the same room.

•      --->      Your child should ask for attention when you are reading a book and not paying attention to them bothers them.

•      --->      As soon as your child asks for attention, put your book down and provide them your full attention instantaneously.
  Note: As your child consistently displays the replacement behavior of asking for attention, slowly increase the time between when your child makes the request and when you provide attention in small intervals (1 second, 2 seconds, 5 seconds, etc.) This will help your child learn to wait in instances when you cannot provide attention immediately.

•      --->      Provide a great deal of verbal praise after you pay attention to your child. Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For interfering behavior replacement goals, the removal of the antecedent or stimulus or providing what your child asked for is the reward and should be provided as instantaneously as possible. 

• Step 2: An initial / specific discriminative stimulus (SD) should be selected that will cue your child that the task will start. This SD can be a visual SD, such as a picture of someone raising their hand and asking for attention, or a verbal SD (“Time to practice asking for attention when I’m reading a book!” or “Let’s practice asking for attention when your parent is reading a book!”).
• Step 3: Collect baseline level data for the skill acquisition target (i.e., asking for attention when a parent is reading a book) by providing the SD from Step 2 and allowing your child to attempt their part independently. The baseline level will vary according to your child and their specific abilities. As an example, you can count how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Note that this baseline collection data step is for the skill acquisition target, and baseline level data for the interfering behavior may already be present in your child’s treatment plan.
• Step 4: To begin the trial to monitor progress towards meeting the skill acquisition target (i.e., asking for attention when a parent is reading a book), provide the SD from Step 2, follow the task analysis from Step 1, and allow your child to attempt their part independently. When your child is successful, instantaneously grant their request, for example, instantaneously provide them with your full attention. You can then, if appropriate, provide verbal praise for your child, such as saying, “Good job at asking for attention!” If the behavior was not displayed, end the trial and provide the appropriate level of prompting on the following trial. For example, employ a model prompt to show your child what to do at the beginning of the following trial (e.g., model for your child how to ask for attention, for example as suggested immediately above under Item g in A-B-Cs Groundwork). Note that for interfering behavior replacement goals, positive reinforcement such as a favorite snack or toy should not be used. For these goals, the removal of the antecedent or stimulus or providing what your child has asked for is the reward and should be provided instantaneously. 
• Step 5: Collect data on how your child makes progress on the skill acquisition target of asking for attention when a parent is reading a book. For example, track progress by counting how many times your child is able to complete their part of the task analysis independently (i.e., successful attempts). Alternatively, count how many times your child is unable to complete their part of the task analysis independently (i.e., unsuccessful attempts).
• Step 6: Collect data on how your child makes progress on decreasing self-injurious behavior. For example, count the number of instances your child hurts themself instead of asking for attention over a certain period of time (e.g., a session, a certain number of sessions, etc.). Alternatively, count the number of instances your child hurts themself rather than asking for attention over a certain time period (e.g., 1 month, 3 months, etc.).