punishment is a very controversialissue and there is very little recent work by behavior analysts about thesubject. Most current references have involved the treatment of SIB severe andrefractory to non-aversive interventions, and have been published sometimes injournals not very significant in the field of applied behavior analysis(Israel and colleagues, 2010; van Oorsouw and colleagues, 2008; Salvy andcolleagues, 2004; Linscheid and Rochenbach, 2002).While devices like SIBIS proved to be very effectivein treating severe cases of SIB maintained by automatic reinforcementrefractory to all other treatment modalities available, it is important thattheir use can be based on ethical perspectives and scientific research. Their use would be unthinkable in the treatmentof severe SIB, for example, exhibited by a person affected by a medical conditionrelated to pain, when this condition increases the frequency of SIB, as in somecases of otitis media [ear infection] or other diseases involving pain.Breau and colleagues (2003) indicated relationshipsbetween pain and SIB in nonverbal children with severe disabilities, andsuggested that children affected by medical problems associated with chronicpain may exhibit different topographies of SIB compared to those exhibited by childrenwithout pain. In cases of SIB maintained by automatic negative reinforcement,the use of devices like SIBIS could suppress the only possible ways to theperson to produce some relief of pain or discomfort. As much as these wereinjurious ways of relieving, would be ethically very questionable to suppress theonly behavior able to bring some relief, without offering any other possibilityin this direction and, most importantly, without offering treatments foractually resolving physical problems related to the etiology of discomfort orpain. This argument may suggest that the use of devices such as SIBIS in casesof SIB maintained by automatic negative reinforcement should becontraindicated.In cases of SIB maintained by automatic positivereinforcement, topographies observed may be different from those observed incases of SIB maintained by automatic negative reinforcement, which also occursin the case of SIB precursor behaviors in both cases. Precursor behaviors arebehaviors whose occurrences can often be seen immediately before the occurrenceof a behavior which is the object of observation (Smith and Churchill, 2002).Fahmie and Iwata (2011) pointed out recently in areview of the research on SIB precursor behaviors that only in one patient among34 of the total sample, could be identified a precursor of SIB maintained byautomatic reinforcement. The study found, however, various topographies andfunctions of precursor behaviors of social maintained SIB. These resultssuggest the need for more detailed studies focused on descriptions of precursorsof SIB maintained by automatic reinforcement. According to anecdotal accountsprovided by parents, teachers and rehabilitation professionals, while in SIBmaintained by automatic negative reinforcement, precursors are often facialexpressions of pain or discomfort, in cases of SIB maintained by automatic positivereinforcement, precursors can include quiet facial expressions or even smiles,which may continue to occur even during the period in which the person remainsengaged in SIB. For more such cases are generally included in one category,called "SIB maintained by automatic reinforcement", it is plausibleto suppose that such cases are verydifferent, and should be treated in different ways as well.In some cases of SIB maintained by automatic positivereinforcement, it is hypothesized that neurobiological alterations may beresponsible for