Facial Screening

The treatment of self-injurious behavior is often a daunting task for therapists working with autistic, mentally handicapped, and organically disabled children or adults. Numerous techniques such as over-correction, time-out, water spray, aversive tickling, and contingent restraint have been used to try to suppress and eliminate self-injurious behaviors. The technique of facial screening has also been used and was the focus of several reviews and studies beginning in the 1970s and 1980s.

Facial screening is a procedure that involves visual occlusion, that is, covering an individual's face (usually with a terry cloth towel or opaque bib) for a specific amount of time as a consequence of self-injurious or other problem behavior. Theoretically, facial screening serves as a mild punisher. To employ the technique, the patient and the therapist sit in chairs closely facing each other. A bib or towel is placed or tied around the patient's neck and the therapist lifts the bib up and holds it over the patient's face as a consequence of the individual engaging in self-injurious behavior. Blind-folds have also been used. The length of time that the facial screen is applied is normally from 30 seconds to 1 minute, but longer time periods have been used.

The development of facial screening came about as an alternative to other types of contingent punishment because other punishments were either too aversive (e.g., shock therapy) or proved ineffective. One of the advantages of facial screening is that the patient is not subjected to any physical pain or danger (and thus eliminates the need for the therapist to apply a physical punisher in response to self-injurious behavior). Facial screening is thought to produce a rapid suppression of self-injurious behaviors in patients. It is also cost effective, portable, and relatively easy to use. A disadvantage of this technique is that it may be considered aesthetically unappealing. Care also needs to be taken to prevent accidents such as falls if blindfolds are used.

Although facial screening has received little current attention in the research literature, several case studies and single-case design experiments suggest that facial screening may be effective in reducing the occurrence of several types of self-injurious behaviors such as face slapping, hand clapping, thumb biting, and hair picking. It has also been shown to be effective in treating trichotillomania and compulsions but has been reported to be ineffective in the treatment of stereotypy. Because facial screening has been found to reduce self-injurious behaviors quickly, the effects of its use should be noticeable after its first few applications. Failure to decrease the number and/or frequency of the self-injurious behaviors after applying facial screening is thus usually indicative that facial screening may be an inappropriate technique for that specific individual.