Sensory-integrated habit reversal intervention for hair pulling and classroom engagement in children with autism: A multiple-baseline pilot study.

BACKGROUND: Hair pulling is a body-focused repetitive behavior frequently observed in individuals with autism and is increasingly conceptualized as a developmentally mediated self-regulatory behavior that may interfere with adaptive participation across everyday contexts. Although habit reversal training (HRT) has demonstrated efficacy for reducing repetitive behaviors, evidence supporting its implementation in naturalistic settings, particularly when integrated with sensory-regulation supports remains limited.

METHODS: This study examined the effects of a sensory-integrated habit reversal (SI-HR) intervention on hair pulling and functional engagement in autistic children within a naturalistic educational context. A multiple-baseline across participants single-case experimental design was employed with eight autistic students (four boys, four girls) aged 8-14 years. Following staggered baseline phases, trained school personnel implemented a manualized intervention combining core HRT components (awareness training, competing responses, and stimulus control) with individualized sensory-regulation strategies embedded within daily routines. Hair pulling was measured using partial-interval recording, and engagement was assessed using momentary time sampling as an indicator of attentional regulation and adaptive participation. Treatment fidelity, interobserver agreement, and social validity were evaluated.

RESULTS: Visual analysis and nonoverlap indices demonstrated consistent and immediate reductions in hair pulling across participants, with large effects (NAP range = 0.92-1.00) and maintenance of gains during a maintenance/probe phase. Functional engagement increased for most participants, although the magnitude of change varied. Teachers and caregivers rated the intervention as feasible and acceptable under typical educational conditions.

CONCLUSIONS AND RECOMMENDATIONS: Findings provide preliminary support for a sensory-integrated behavioral approach to reducing body-focused repetitive behavior in autistic children, with associated improvements in functional engagement. These findings should be interpreted cautiously given the multicomponent nature of the intervention and the small sample size, underscoring the need for replication, component analyses, and extended follow-up across developmental and rehabilitative contexts.