"Some medical conditions such as Lesch-Nyhan syndrome, Cornelia de Lange syndrome, and otitis media have been associated with self-injury in some individuals. You will obviously need to have a medical examination to rule out these or other more common medical influences including seizures, infections, ulcers, and so forth. Other factors such as not getting enough sleep, dietary changes, an environment that is too noisy, or just a general disruption in a person’s life can also play a role in someone’s behavior problems. You can and should try to assess and remedy these situations in the process of planning an intervention.

"However, our work in this area indicates that many if not most of the people we encounter display problem behavior primarily in the four categories we described (i.e., social attention, tangibles, escape, and sensory feedback). Although the other influences can also have an effect (e.g., being tired), knowing how attention, tangibles, escape, and sensory factors motivate behaviors has been very helpful in designing treatments (Durand, 1990)."