Using competing stimuli with an adult with stereotypic skin picking: A case study of assessment, treatment, and generalization

The competing stimulus assessment (CSA) is used to identify stimuli that are associated with high levels of engagement and low levels of problem behavior. However, few studies have used CSA results for adults with problem behavior. The goal of this study was to expand on previous literature by targeting an adult's self-injurious skin picking, while incorporating caregivers into treatment and examining reduction maintenance. Noelle was a 27-year-old female diagnosed with autism spectrum disorder and intellectual disability referred to an intensive outpatient clinic. Functional assessment results suggested that skin picking was maintained by automatic reinforcement. Treatment included noncontingent access to competing stimuli identified via a CSA with response disruption and response promotion tactics. This intervention reduced skin picking to near zero rates, was effectively implemented by caregivers, and treatment gains were maintained over 5 months. Limitations and future considerations for behavior reduction procedures with adults are discussed.