The case of a 26-year-old man who had Prader-Willi syndrome and health threatening self-injury in the form of rectal picking is described. Functional behavioral assessment and analysis before intervention suggested that both nonrectal and rectal picking occurred because the behaviors sometimes produced social attention, escape from nonpreferred situations, and sensory pleasurable stimulation. Intervention was evaluated at the man's vocational training program. The behavior support plan included time-limited bathroom visits, functional communication training, and differential positive reinforcement. Intervention eliminated rectal picking, was associated with improved health status, and remained effective over a nearly 8-month period.
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