# The Handbook of High-Risk Challenging Behaviors in People with Intellectual and Developmental Disabilities **Edited by:** James K. Luiselli, Ed.D., ABPP, BCBA-D --- ## Table of Contents ### I Self-Injurious Behavior 1. Biological Perspectives on Self-Injury Among People with Intellectual and Neurodevelopmental Disabilities Frank J. Symons and Craig H. Kennedy ....................................................3 2. Functional Behavioral Assessment and Functional Analysis of Self-Injury David E. Kuhn.................................................................................21 3. Function-Based Behavioral Intervention for Self-Injury Johannes Rojahn, Iser G. DeLeon, Griffin W. Rooker, Michelle A. Frank-Crawford, Abbey B. Carreau-Webster, and Yanerys Leon-Enriquez ..................................................................39 ### II Aggressive Behavior 4. Environmental Determinants of Aggressive Behavior Johnny L. Matson and Alison M. Kozlowski.............................................63 5. Biopsychosocial Features Influencing Aggression: A Multimodal Assessment and Therapy Approach William I. Gardner, Dorothy M. Griffiths, and Jeffery P. Hamelin....................83 ### III Sexual Offending Behavior 6. Risk Assessment for Sexual Offending 7. Behavioral Assessment and Intervention for Sex Offenders with Intellectual and Developmental Disabilities Timothy R. Vollmer, Jorge R. Reyes, and Stephen F. Walker .........................121 8. Problem-Solving Treatment for Sexual Offending Christine Maguth Nezu, Travis A. Cos, and Arthur M. Nezu ......................145 ### IV Health-Threatening Eating Disorders 9. Behavioral Assessment and Treatment of Pica Louis P. Hagopian, Natalie U. Rolider, and Griffin W. Rooker ......................161 10. Ruminative Vomiting Jonathan Tarbox, Amy L. Kenzer, and Michele R. Bishop............................177 11. Obesity and Weight Regulation Richard K. Fleming ..........................................................................195 ### V Criminal Behavior 12. People with Intellectual and Developmental Disabilities in the Criminal Justice System Susan Carol Hayes...........................................................................211 13. The Death Penalty, the Courts, and Intellectual Disabilities J. Gregory Olley..............................................................................229 ### VI Therapeutic (Physical) Restraint 14. Therapeutic Implementation of Physical Restraint James K. Luiselli .............................................................................243 15. Regulatory Governance of Physical Restraint in Schools Joseph B. Ryan and Reece L. Peterson...................................................257 16. Emergency Physical Restraint: Considerations for Staff Training and Supervision David Lennox, Mark A. Geren, and David Rourke...................................271 --- ## Assessment and Treatment of Pica Pica is defined diagnostically as: 1. Consumption of nonnutritive items for more than a month, 2. Consumption of nonnutritive items inappropriate to developmental age, 3. Eating that is not part of culturally sanctioned activity, and 4. A behavior severe enough to require independent clinical attention when other clinical services are being provided for another mental disorder (American Psychological Association, 2000). Several severe health risks are associated with pica, including lead poisoning, intestinal perforation, and obstruction. The prevalence of pica in people with IDD (Intellectual and Developmental Disabilities) has been reported to be between 5.7% and 25.8%. In the largest study, pica occurred in 25.8% of a sample of 991 institutionalized individuals. ## Functional Behavioral Assessment To assess the operant contingencies maintaining pica, a functional behavioral assessment (FBA) is recommended. There are two categories of FBA procedures: indirect methods (interviews and questionnaires) and direct methods (observations). Experimental methods (i.e., functional analysis, FA) are the most rigorous and directly manipulate relevant antecedent and consequent variables. --- ## Behavioral Treatment of Pica Two broad classes of intervention have been shown to be successful: medical and behavioral interventions. Medical interventions, such as correcting identified nutritional deficits, have shown promise. Behavior analytic interventions typically involve multiple components, including antecedent interventions (e.g., noncontingent reinforcement) and consequent interventions (e.g., reinforcement, response blocking). ### Noncontingent Reinforcement (NCR) NCR involves delivering a reinforcer on a timed schedule independent of the individual's behavior. Access to reinforcement may reduce the motivation to perform the behavior. ### Response Blocking Response blocking involves preventing pica from occurring and has shown effectiveness in reducing problem behavior maintained by sensory reinforcement. ### Differential Reinforcement Differential reinforcement of other behavior (DRO) involves providing reinforcement for not engaging in pica. This has been less frequently evaluated but has shown some effectiveness in various studies. --- ## Conclusions and Recommendations The assessment and treatment of pica have evolved, with an increased focus on understanding behavioral determinants rather than relying solely on default interventions. The integration of reinforcement-based procedures relative to punitive measures is increasing, highlighting the importance of comprehensive, individualized treatment approaches.