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Ala’i-Rosales S, Cihon JH, Currier TDR, Ferguson JL, Leaf JB, Leaf R, McEachin J, Weinkauf SM. The Big Four: Functional Assessment Research Informs Preventative Behavior Analysis. Behav Anal Pract 2019; 12:222-234. [PMID: 30918789 PMCID: PMC6411551 DOI: 10.1007/s40617-018-00291-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Current practice guidelines suggest that the assessment and treatment of challenging behavior should consist of conducting a functional behavior assessment following the onset of problem behavior. This assessment process can include indirect and direct assessment, as well as manipulation of variables to determine function. The purpose of this article is to outline a proposal that would add prevention practices to early intervention guidelines for problem behavior. Based on decades of research, the suggestion is to proactively teach children at risk for problem behavior to navigate four of the most common conditions that have been demonstrated to occasion problem behavior. Prevention is made a possibility because a large body of research examining the conditions under which challenging behavior occurs has been reliably replicated. Preventative approaches are an emerging phenomenon and reflect a progression in the practice of behavior analysis. Prevention may lead to acquisition of prosocial behavior before problems arise, to expedited and enhanced treatment, to increased access to favorable learning environments, and, we hope, to improvement in the quality of life for many children at risk for the development of problem behavior.
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Affiliation(s)
- Shahla Ala’i-Rosales
- Department of Behavior Analysis, The University of North Texas, 1155 Union Circle, Box 310919, Denton, TX 76203 USA
| | - Joseph H. Cihon
- Autism Partnership Foundation, BCBA, 200 Marina Drive, Seal Beach, CA 90740 USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA USA
| | | | - Julia L. Ferguson
- Autism Partnership Foundation, BCBA, 200 Marina Drive, Seal Beach, CA 90740 USA
| | - Justin B. Leaf
- Autism Partnership Foundation, BCBA, 200 Marina Drive, Seal Beach, CA 90740 USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA USA
| | - Ron Leaf
- Autism Partnership, Seal Beach, CA USA
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Mulder PA, Huisman S, Landlust AM, Moss J, Piening S, Hennekam RC, van Balkom IDC. Development, behaviour and autism in individuals with SMC1A variants. J Child Psychol Psychiatry 2019; 60:305-313. [PMID: 30295920 DOI: 10.1111/jcpp.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Development and behaviour in Cornelia de Lange Syndrome (CdLS), including autism characteristics, have been described infrequently stratified to genetic cause and only a few studies have considered behavioural characteristics in relation to developmental level. Here, we describe the behavioural phenotype in individuals with CdLS with SMC1A variants. METHODS We performed an international, interdisciplinary study on 51 individuals with SMC1A variants. Results of questionnaire studies are compared to those in individuals with Down Syndrome and with Autism Spectrum Disorder. Results on cognition and self-injurious behaviour (SIB) are compared to those in individuals with CdLS caused by NIPBL variants. For Dutch participants with SMC1A variants we performed direct in-person assessments of cognition, autism, and added an interview and questionnaire on adaptive behaviour and sensory processing. RESULTS Individuals with SMC1A variants show a higher cognitive level and less SIB than individuals with NIPBL variants. Individuals with SMC1A variants without classic CdLS phenotype but with a Rett-like phenotype show more severe intellectual disability and more SIB compared to those with a CdLS phenotype. Autism is less present if outcomes in direct in-person assessments are evaluated taking developmental level into account compared to results based on a questionnaire. CONCLUSIONS Behaviour in individuals with CdLS should be evaluated taking genetic cause into account. Detailed interdisciplinary approaches are of clinical importance to inform tailored care and may eventually improve quality of life of patients and families.
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Affiliation(s)
- Paul A Mulder
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Sylvia Huisman
- Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands.,Prinsenstichting Institute, Purmerend, the Netherlands
| | - Annemiek M Landlust
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Sigrid Piening
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Raoul C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands.,Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands
| | - Ingrid D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of Youth Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
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53
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Doshi PK, Hegde A, Desai A. Nucleus Accumbens Deep Brain Stimulation for Obsessive-Compulsive Disorder and Aggression in an Autistic Patient: A Case Report and Hypothesis of the Role of Nucleus Accumbens in Autism and Comorbid Symptoms. World Neurosurg 2019; 125:387-391. [PMID: 30797934 DOI: 10.1016/j.wneu.2019.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autism spectrum disorder represents a set of developmental disorders characterized by lack of social interaction and verbal and nonverbal communication in the first 3 years of life. It is also associated with several comorbidities, including epilepsy, aggression, self-mutilating behavior, and obsessive-compulsive behavior. In some cases, obsessive-compulsive disorder (OCD) develops. The nucleus accumbens (NAc) plays a key role in reward circuitry and is involved in the control of OCD and aggression. CASE DESCRIPTION A 42-year-old woman with autism was offered NAc deep brain stimulation for her comorbidities of OCD and aggression. The NAc was targeted using standard stereotactic methods, and postoperative scans confirmed the position of the active electrode to be within the NAc. The patient experienced significant symptom relief. At 1-year follow-up, the Yale-Brown Obsessive Compulsive Scale score for OCD, excluding items 1-5 of the scale, improved from 19 to 5. Hamilton Depression Scale and Hamilton Anxiety Scale scores similarly improved from 20 to 15 and from 30 to 18, respectively. Social Communication Questionnaire Current version for autism score improved from 26 to 16. Subscores for reciprocal social interactionimproved from 13 to 8; for communication improved from 5 to 4; and for restricted, repetitive, and stereotyped patterns of behavior improved from 6 to 3. CONCLUSIONS This case report illustrated the role of the NAc in OCD and aggression in an autistic patient. We discussed the role of the NAc as a target to explain the outcome of this case.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India.
| | - Anaita Hegde
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India
| | - Amit Desai
- Department of Psychiatry, Jaslok Hospital and Research Centre, Mumbai, India
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Shkedy G, Shkedy D, Sandoval-Norton AH. Treating self-injurious behaviors in autism spectrum disorder. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1682766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gary Shkedy
- Director of Research, Alternative Teaching Strategy Center, 10640 Scripps Ranch Blvd Suite 200, San Diego, CA 92131, USA
| | - Dalia Shkedy
- Executive Director, Alternative Teaching Strategy Center 10640 Scripps Ranch Blvd Suite 200, San Diego, CA 92131, USA
| | - Aileen H. Sandoval-Norton
- Clinical Director, Alternative Teaching Strategy Center, 10640 Scripps Ranch Blvd Suite 200, San Diego, CA 92131, USA
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Handen BL, Mazefsky CA, Gabriels RL, Pedersen KA, Wallace M, Siegel M. Risk Factors for Self-injurious Behavior in an Inpatient Psychiatric Sample of Children with Autism Spectrum Disorder: A Naturalistic Observation Study. J Autism Dev Disord 2018; 48:3678-3688. [PMID: 29368233 DOI: 10.1007/s10803-017-3460-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Limited information about self-injurious behavior (SIB) is known for children and adolescents with Autism Spectrum Disorder (ASD) who require intensive behavioral health interventions. We examined risk-factors for SIB in 302 individuals with ASD (ages 4-20) admitted to six specialized psychiatric inpatient units. Seventy-four percent were reported by a caregiver to display SIB, however, only 25% were observed to engage in daily SIB during hospitalization. Those exhibiting SIB across environments had significantly higher ratings on caregiver questionnaires of SIB severity. Tree-structured classification was used to develop and validate two predictive models, one indicating which inpatient youth with ASD are likely to have SIB and a second indicating which individuals with SIB at home are likely to continue in an inpatient setting.
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Affiliation(s)
- Benjamin L Handen
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Robin L Gabriels
- Children's Hospital of Colorado, 13123 E 16th Ave., Aurora, CO, 80045, USA
| | - Kahsi A Pedersen
- Tufts University School of Medicine, 236 Gannett Drive, South Portland, ME, 04106, USA
| | - Meredith Wallace
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Matthew Siegel
- Tufts University School of Medicine, 236 Gannett Drive, South Portland, ME, 04106, USA
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56
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Folch A, Cortés MJ, Salvador-Carulla L, Vicens P, Irazábal M, Muñoz S, Rovira L, Orejuela C, Haro JM, Vilella E, Martínez-Leal R. Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:1018-1029. [PMID: 29607562 DOI: 10.1111/jir.12487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 11/14/2017] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. METHOD This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. RESULTS Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People with profound ID without co-morbid ASD symptoms showed similar results concerning SIB prevalence and topographies. CONCLUSIONS Knowledge on risk factors and topographies of SIB might play a vital role in the development of prevention strategies and management of SIB in people with IDD. The mere presence of ASD symptoms, regardless of its severity level, can be a crucial factor to be taken into account in assessing SIB. Accordingly, the presence of SIB in people with ID, especially when presented with a varied number of topographies, might provide guidance on ASD differential diagnosis.
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Affiliation(s)
- A Folch
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - M J Cortés
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
| | - L Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P Vicens
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
- Research Center in Behavioral Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Laboratory of Toxicology and Environmental Health, Universitat Rovira i Virgili, Tarragona, Spain
| | - M Irazábal
- Parc Sanitari Sant Joan de Déu, Spain
- Faculty of Education, Universitat de Barcelona, Barcelona, Spain
| | - S Muñoz
- Plena Inclusión España, Madrid, Spain
| | - L Rovira
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - C Orejuela
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J M Haro
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | - E Vilella
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Institut Pere Mata, University Psychiatric Hospital, Reus, Spain
| | - R Martínez-Leal
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD), Fundació Villablanca, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM), Spain
- Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain
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57
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Bradley V, Hiersteiner D, Rotholz D, Maloney J, Li H, Bonardi A, Bershadsky J. Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:1043-1057. [PMID: 30022570 DOI: 10.1111/jir.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND For people with intellectual and developmental disabilities, self-injurious behaviour (SIB) can have serious negative effects on both health and quality of life. This descriptive analysis will provide information on the characteristics and outcomes of a subsample of individuals who are identified as needing some or extensive support for SIB in the National Core Indicators Adult Consumer Survey sample. METHODS The data for this analysis come from states that participated in the 2015-2016 data collection cycle of National Core Indicators Adult Consumer Survey which is a face-to-face survey of adults receiving services through state developmental disability agencies. RESULTS The characteristics and outcomes of individuals who need at least some support for SIB differ from those of individuals with intellectual and developmental disabilities who do not need support for SIB. Individuals with SIB support needs, for example, tend to live in more structured settings, have fewer relationships, less inclusion in their communities and poorer employment outcomes. CONCLUSIONS The exploratory descriptive analysis concludes with suggested recommendations for more standardised definitions of SIB in public systems, enhanced behaviour plan protocols and the need for additional research.
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Affiliation(s)
- V Bradley
- Human Services Research Institute, Cambridge, MA, USA
| | - D Hiersteiner
- Human Services Research Institute, Cambridge, MA, USA
| | - D Rotholz
- Department of Pediatrics, Center for Disability Resources, School of Medicine, Columbia, SC, USA
| | - J Maloney
- Human Services Research Institute, Cambridge, MA, USA
| | - H Li
- Human Services Research Institute, Cambridge, MA, USA
| | - A Bonardi
- Human Services Research Institute, Cambridge, MA, USA
| | - J Bershadsky
- Human Services Research Institute, Cambridge, MA, USA
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58
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Holth F, Walby F, Røstbakken T, Lunde I, Ringen PA, Ramleth RK, Romm KL, Tveit T, Torgersen T, Urnes Ø, Kvarstein EH. Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation. Nord J Psychiatry 2018; 72:605-612. [PMID: 30348040 DOI: 10.1080/08039488.2018.1511751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Extreme self-harming behavior is a major challenge for patients and health services. Nevertheless, this patient population is poorly described in research literature. AIMS The aim of this study was to assess the volume of patients with extensive psychiatric hospitalization due to extreme self-harming behaviors, the extent of severe medical sequelae, and collaboration problems within health services. METHODS In a national screening investigation, department managers in 83 adult psychiatric inpatient institutions across all health regions in Norway were invited to participate in a brief, prepared, telephone interview. RESULTS Sixty-one interviews were completed. Extensive hospitalization (prolonged or multiple) due to extreme self-harm was reported for the last year in all health regions and in 427 individual cases. Mean number of cases did not differ by region. Psychiatric hospitalizations were more frequent in hospital units than mental health centers. In 109 of the cases, self-harming behavior had severe medical consequences, including five deaths. In 122 of the cases, substantial collaboration problems within the health services were reported (disagreements on diagnosis, treatment needs and resources). Extensive (long-term) hospitalization was particularly associated with the combination of severe medical sequelae and collaboration problems. CONCLUSION This investigation confirms a noteworthy, nationwide, population of severely self-harming inpatients with extensive health service use, prevalent severe medical complications, and unsatisfactory collaboration within health services. These preliminary results are alarming, and indicate a need for more profound understanding of highly complex and severe cases.
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Affiliation(s)
- Fredrik Holth
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Fredrik Walby
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Thea Røstbakken
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Ingeborg Lunde
- c Trauma and Suicide Prevention , Regional Centre on Violence , East, Oslo , Norway
| | | | | | | | - Tone Tveit
- e Haukeland University Hospital , Oslo , Norway
| | | | - Øyvind Urnes
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Elfrida Hartveit Kvarstein
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway.,g Institute for Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
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Carter Leno V, Vitoratou S, Kent R, Charman T, Chandler S, Jones CRG, Happé F, Baird G, Pickles A, Simonoff E. Exploring the neurocognitive correlates of challenging behaviours in young people with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1152-1164. [DOI: 10.1177/1362361318769176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Virginia Carter Leno
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Silia Vitoratou
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Rachel Kent
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Susie Chandler
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Francesca Happé
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gillian Baird
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Rattaz C, Michelon C, Munir K, Baghdadli A. Challenging behaviours at early adulthood in autism spectrum disorders: topography, risk factors and evolution. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:637-649. [PMID: 29797498 PMCID: PMC6790981 DOI: 10.1111/jir.12503] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/08/2018] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Challenging behaviours are highly prevalent in children and adolescents with autism spectrum disorders (ASD), but little is known about the prevalence and course of these behaviours during adulthood. The aims of this study were to describe the topography of challenging behaviours in a cohort of 106 young adults with ASD and to identify the risk factors for challenging behaviours. Our secondary objective was to study the changes in challenging behaviours from adolescence to early adult years. METHOD The present study uses data from the EpiTED prospective follow-up study in France. The presence of challenging behaviours was assessed by the Aberrant Behaviour Checklist (ABC) completed by parent informants. Several dimensions of behaviour were studied: irritability, stereotypy, lethargy, hyperactivity and self-injury. Clinical variables were collected on ASD symptom severity, cognitive and language levels, adaptive behaviours and comorbid medical disorders. RESULTS The presence of challenging behaviours at early adulthood was related to the young adult's cognitive and language level, ASD symptom severity and comorbid gastrointestinal and sleep disorders. The main risk factor for challenging behaviours was ASD symptom severity. The level of language impairment was a significant predictor of self-injury. Gastrointestinal disorders were a significant predictor of stereotypy. The change in behaviour topography from adolescence to early adult years corresponded with decreased parent report of hyperactivity, but no significant decrease in parent reports of irritability, stereotypy, lethargy and self-injurious behaviours. CONCLUSIONS The challenging behaviours in individuals with ASD persist in early adulthood and are related to core symptom severity, levels of cognitive and language impairments and medical comorbidity. The results emphasise the importance of early interventions for children with ASD to target cognitive and language abilities and to alleviate the severity of ASD symptoms. They also underscore the need to enhance opportunities for individuals with ASD to better communicate discomforts and pain in the context of medical illness.
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Affiliation(s)
- C Rattaz
- Centre Ressources Autisme, CHRU, Montpellier, France
| | - C Michelon
- Centre Ressources Autisme, CHRU, Montpellier, France
| | - K Munir
- Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Baghdadli
- Centre Ressources Autisme, CHRU, Montpellier, France
- Centre de Recherche en Épidémiologie et Santé des Populations, U1178, INSERM, Paris, France
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61
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Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Brief Report: Self-Injurious Behaviors in Preschool Children with Autism Spectrum Disorder Compared to Other Developmental Delays and Disorders. J Autism Dev Disord 2018; 48:2558-2566. [PMID: 29429009 PMCID: PMC5997504 DOI: 10.1007/s10803-018-3490-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30-68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (95% confidence interval (95% CI) 1.53, 2.97)]. In subgroup analyses, SIB prevalence was higher in ASD versus DD without ASD symptoms [aOR 4.42 (95% CI 2.66, 7.33)], but was similar between ASD and DD with ASD symptoms [aOR 1.09 (95% CI 0.68, 1.77)]. We confirmed higher prevalence of SIB in ASD versus DD, independent of confounders. In children with DD, SIB prevalence increased with more ASD symptoms. These findings are informative to clinicians, researchers, and policymakers.
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Affiliation(s)
- G N Soke
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS E-86, Atlanta, GA, 30341, USA.
| | - S A Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - C R Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - R A Vasa
- School of Medicine, Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - L-C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - C DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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Erturk B, Machalicek W, Drew C. Self-Injurious Behavior in Children With Developmental Disabilities: A Systematic Review of Behavioral Intervention Literature. Behav Modif 2017; 42:498-542. [PMID: 29179569 DOI: 10.1177/0145445517741474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We reviewed single-case research studies examining the effects of behavioral interventions for self-injurious behavior (SIB) in young children with autism and developmental disabilities. Systematic searches of electronic databases, journals, and reference lists identified 46 studies (66 participants younger than the age of 12) meeting inclusion criteria. Studies were examined based on (a) participant demographics, (b) topography and function of SIB, (c) type of functional behavior assessment (FBA), (d) intervention procedures and outcomes, and (e) experimental design and measurement. Intervention strategies were categorized as antecedent manipulations, teaching behavior, consequence-based procedures, and/or extinction procedures. Positive outcomes were reported for 78% of participants in the reviewed studies and 88% of the participants were diagnosed with autism. Results suggest the effectiveness of behavioral interventions to decrease SIB for young children with disabilities; however, the frequent use of packaged interventions without component analysis limits the conclusiveness of any treatment recommendation. Suggestions for future research are discussed.
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63
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Potential Risk Factors for the Development of Self-Injurious Behavior among Infants at Risk for Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1403-1415. [PMID: 28220358 PMCID: PMC5385192 DOI: 10.1007/s10803-017-3057-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Prevalence of self-injurious behavior (SIB) is as high as 50% among children with autism spectrum disorder (ASD). Identification of risk factors for the development of SIB is critical to early intervention and prevention. However, there is little empirical research utilizing a prospective design to identify early risk factors for SIB. The purpose of this study was to evaluate behavioral characteristics predicting SIB at age 2 years among 235 infants at high familial risk for ASD. Logistic regression results indicated that presence of SIB or proto-SIB and lower developmental functioning at age 12 months significantly predicted SIB at 24 months. A pattern of persistent SIB over this period was associated with a diagnosis of autism and poorer cognitive and adaptive outcomes.
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Summers J, Shahrami A, Cali S, D'Mello C, Kako M, Palikucin-Reljin A, Savage M, Shaw O, Lunsky Y. Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input. Brain Sci 2017; 7:brainsci7110140. [PMID: 29072583 PMCID: PMC5704147 DOI: 10.3390/brainsci7110140] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/11/2017] [Accepted: 10/23/2017] [Indexed: 12/27/2022] Open
Abstract
This paper provides information about the prevalence and topography of self-injurious behavior in children and adults with autism spectrum disorder and intellectual disability. Dominant models regarding the etiology of self-injury in this population are reviewed, with a focus on the role of reactivity to pain and sensory input. Neuroimaging studies are presented and suggestions are offered for future research.
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Affiliation(s)
- Jane Summers
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Ali Shahrami
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Stefanie Cali
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Chantelle D'Mello
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Milena Kako
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | | | - Melissa Savage
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Olivia Shaw
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada.
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Soke GN, Rosenberg SA, Hamman RF, Fingerlin T, Robinson C, Carpenter L, Giarelli E, Lee LC, Wiggins LD, Durkin MS, DiGuiseppi C. Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder-A Population-Based Study. J Autism Dev Disord 2017; 46:3607-3614. [PMID: 27565654 DOI: 10.1007/s10803-016-2879-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Self-injurious behaviors (SIB) have been reported in more than 30 % of children with an autism spectrum disorder (ASD) in clinic-based studies. This study estimated the prevalence of SIB in a large population-based sample of children with ASD in the United States. A total of 8065 children who met the surveillance case definition for ASD in the Autism and Developmental Disabilities Monitoring (ADDM) Network during the 2000, 2006, and 2008 surveillance years were included. The presence of SIB was reported from available health and/or educational records by an expert clinician in ADDM Network. SIB prevalence averaged 27.7 % across all sites and surveillance years, with some variation between sites. Clinicians should inquire about SIB during assessments of children with ASD.
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Affiliation(s)
- Gnakub N Soke
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Steven A Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Tasha Fingerlin
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Cordelia Robinson
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Carpenter
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19102, USA
| | - Li-Ching Lee
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Maureen S Durkin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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66
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Akram B, Batool M, Rafi Z, Akram A. Prevalence and Predictors of Non-Suicidal Self-Injury among Children with Autism Spectrum Disorder. Pak J Med Sci 2017; 33:1225-1229. [PMID: 29142569 PMCID: PMC5673738 DOI: 10.12669/pjms.335.12931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: To find the prevalence as well as to identify the predictors as protective and risk factors of Non-Suicidal Self-Injury (NSSI) among children with autism spectrum disorder (ASD). Methods: In this analytical cross sectional survey 83 children with ASD age range from 8 to 18 years were selected through convenient sampling technique from five special schools of Lahore city. The Urdu form of a standardized tool was used to assess NSSI. Results: Statistical analysis indicated overall point prevalence of NSSI was 33%. Moreover banging/self-beating (47%), scratching (38), pinching (35%), picking scabs (33%), self-biting (32%), pulling hair (30%) and rubbing skin (19%) emerged as common forms of challenging behavior. Further regression analysis showed that age B(1.68*, P<.05), gender B(3.72, P<.001) and severity level of ASD B(1.85***, p<.0001) as risk factors/positive predictors of NSSI. However early intervention (-0.66***, P<.0001) and involvement of parents in counselling (-2.66*, P<.05) emerged as protective factors/negative predictors of NSSI among children with ASD. Conclusion: Non-suicidal self-injury is a serious challenge among children with ASD. Early intervention, counselling and parental involvement in managing the children with ASD will not only prevent but reduce the challenging behaviors.
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Affiliation(s)
- Bushra Akram
- Dr. Bushra Akram, PhD. Assistant Professor, Department of Psychology, University of Gujrat, Gujrat, Pakistan
| | - Mehak Batool
- Mehak Batool, BS Hon's., Student at Department of Psychology, University of Gujrat, Gujrat, Pakistan
| | - Zeeshan Rafi
- Zeeshan Rafi, M.Phil. PhD Scholar, Faculty of Computer Sciences and Management, Istanbul University, Turkey
| | - Abrar Akram
- Abrar Akram. MSc. Faculty of Computer Sciences and Management, Gujrat University, Gujrat, Pakistan
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67
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Richards C, Davies L, Oliver C. Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control. J Autism Dev Disord 2017; 47:701-713. [PMID: 28070787 DOI: 10.1007/s10803-016-3000-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-injury is common in autism spectrum disorder (ASD); however few studies have investigated correlates of self-injury or the putative associations with self-restraint. Questionnaire data on self-injury, self-restraint, health conditions, overactivity/impulsivity and repetitive/restricted behavior were collected on 208 children and 216 adults with ASD (mean age = 24.10, range 6-61). Self-injury and self-restraint were frequent and significantly associated in both children (45.7% and 40.9%, p < 0.001) and adults (49.1, and 42.6%, p < 0.001). Severe self-injury was predicted by lower ability, health conditions and overactivity/impulsivity in children (p < 0.001) and repetitive/restricted behavior and overactivity/impulsivity in adults (p < 0.001). These data provide preliminary support for a developmental model of self-injury and self-restraint in which painful health conditions and compromised behavioral control influence the presence and trajectory of self-injury in ASD.
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Affiliation(s)
- Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Louise Davies
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK.,Forward Thinking Birmingham Learning Disability Team, Oaklands Centre, Raddlebarn Road, Selly Oak, B29 6JB, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK
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Abstract
OBJECTIVES The purpose of this systematic literature review is to describe what is known about fragile X syndrome (FXS) and to identify research gaps. The results can be used to help inform future public health research and provide pediatricians with up-to-date information about the implications of the condition for individuals and their families. METHODS An electronic literature search was conducted, guided by a variety of key words. The search focused on 4 areas of both clinical and public health importance: (1) the full mutation phenotype, (2) developmental trajectories across the life span, (3) available interventions and treatments, and (4) impact on the family. A total of 661 articles were examined and 203 were included in the review. RESULTS The information is presented in the following categories: developmental profile (cognition, language, functional skills, and transition to adulthood), social-emotional profile (cooccurring psychiatric conditions and behavior problems), medical profile (physical features, seizures, sleep, health problems, and physiologic features), treatment and interventions (educational/behavioral, allied health services, and pharmacologic), and impact on the family (family environment and financial impact). Research gaps also are presented. CONCLUSIONS The identification and treatment of FXS remains an important public health and clinical concern. The information presented in this article provides a more robust understanding of FXS and the impact of this complex condition for pediatricians. Despite a wealth of information about the condition, much work remains to fully support affected individuals and their families.
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Affiliation(s)
- Melissa Raspa
- RTI International, Research Triangle Park, North Carolina; and
| | - Anne C Wheeler
- RTI International, Research Triangle Park, North Carolina; and
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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69
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Chen C, Shen YD, Xun GL, Cai WX, Shi LJ, Xiao L, Wu RR, Zhao JP, Ou JJ. Aggressive behaviors and treatable risk factors of preschool children with autism spectrum disorder. Autism Res 2017; 10:1155-1162. [PMID: 28266803 DOI: 10.1002/aur.1751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 12/27/2016] [Accepted: 12/30/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Chen Chen
- Shanghai Key Laboratory of Forensic Medicine; Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, P.R.China, GuangFu West Road 1347#; Shanghai 200063 People's Republic of China
| | - Yi-Dong Shen
- Mental Health Institute of the Second Xiangya Hospital; Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province; 139 Middle Renmin Road Changsha Hunan 410011 People's Republic of China
| | - Guang-Lei Xun
- Shandong Mental Health Center; 49 East Wenhua Road Jinan, Shandong 250014 People's Republic of China
| | - Wei-Xiong Cai
- Shanghai Key Laboratory of Forensic Medicine; Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, P.R.China, GuangFu West Road 1347#; Shanghai 200063 People's Republic of China
| | - Li-Juan Shi
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, People's Republic of China. School of Education, Hunan University of Science and Technology; Xiangtan Hunan People's Republic of China
| | - Lu Xiao
- Mental Health Institute of the Second Xiangya Hospital; Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province; 139 Middle Renmin Road Changsha Hunan 410011 People's Republic of China
| | - Ren-Rong Wu
- Mental Health Institute of the Second Xiangya Hospital; Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province; 139 Middle Renmin Road Changsha Hunan 410011 People's Republic of China
| | - Jing-Ping Zhao
- Mental Health Institute of the Second Xiangya Hospital; Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province; 139 Middle Renmin Road Changsha Hunan 410011 People's Republic of China
| | - Jian-Jun Ou
- Mental Health Institute of the Second Xiangya Hospital; Central South University, The China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province; 139 Middle Renmin Road Changsha Hunan 410011 People's Republic of China
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Abstract
An increasing number of case reports and series document the safe and effective use of electroconvulsive therapy (ECT) in children, adolescents, and young adults with autism spectrum disorder who engage in severe, intractable, repetitive self-injurious behavior (SIB) without environmental or operant function. Although the treatment is very effective for such patients, they typically remain highly dependent on frequent maintenance ECT (M-ECT) to maintain suppression of the SIB achieved during the acute course. Some patients receive M-ECT as frequently as once every 5 days. Such a regimen is quite burdensome for the patient and the patient's family, and the long-term effects of such regimens, starting as early as childhood, are unknown. In this review, we explore the expanding literature supporting the use of ECT for suppressing severe SIB associated with autism spectrum disorder. We also focus on the possible development of alternate nonconvulsive focal forms of brain stimulation, which might replace frequent M-ECT or reduce how frequently a patient needs to receive it. Although there are scarce clinical data currently available supporting these latter treatments, future studies are clearly indicated.
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71
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Dempsey J, Dempsey AG, Guffey D, Minard CG, Goin-Kochel RP. Brief Report: Further Examination of Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:1872-9. [PMID: 26781113 DOI: 10.1007/s10803-016-2704-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Self-injurious behaviors (SIB) are problematic for many children with autism spectrum disorders (ASD). Existing models to explain factors contributing to SIB fail to account for a large proportion of variance in SIB. This study attempted to explain a greater proportion of variance in SIB by addressing methodological/theoretical limitations in previous research using a sample of 2341 youth with ASD. The model comprised of predictors identified by the prior study continued to explain only a small proportion of variance in the SIB score (R (2) = .13). Revisions to the model failed to substantially improve model fit. Results suggest that psychological, cognitive, and behavioral factors alone do not adequately explain common measures of SIB and highlight the need for further research.
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Affiliation(s)
- Jack Dempsey
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Autism Center, Texas Children's Hospital, 8080 N Stadium Drive Ste. 180, Houston, TX, 77054, USA.
| | - Allison G Dempsey
- Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Robin P Goin-Kochel
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Center, Texas Children's Hospital, 8080 N Stadium Drive Ste. 180, Houston, TX, 77054, USA
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High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models. Neuropsychopharmacology 2016; 41:1813-21. [PMID: 26606849 PMCID: PMC4869050 DOI: 10.1038/npp.2015.350] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 01/15/2023]
Abstract
Approximately one quarter of individuals with an autism spectrum disorder (ASD) display self-injurious behavior (SIB) ranging from head banging to self-directed biting and punching. Sometimes, these behaviors are extreme and unresponsive to pharmacological and behavioral therapies. We have found electroconvulsive therapy (ECT) can produce life-changing results, with more than 90% suppression of SIB frequency. However, these patients typically require frequent maintenance ECT (mECT), as often as every 5 days, to sustain the improvement gained during the acute course. Long-term consequences of such frequent mECT started as early as childhood in some cases are unknown. Accordingly, there is a need for alternative forms of chronic stimulation for these patients. To explore the feasibility of deep brain stimulation (DBS) for intractable SIB seen in some patients with an ASD, we utilized two genetically distinct mouse models demonstrating excessive self-grooming, namely the Viaat-Mecp2(-/y) and Shank3B(-/-) lines, and administered high-frequency stimulation (HFS) via implanted electrodes at the subthalamic nucleus (STN-HFS). We found that STN-HFS significantly suppressed excessive self-grooming in both genetic lines. Suppression occurs both acutely when stimulation is switched on, and persists for several days after HFS is stopped. This effect was not explained by a change in locomotor activity, which was unaffected by STN-HFS. Likewise, social interaction deficits were not corrected by STN-HFS. Our data show STN-HFS suppresses excessive self-grooming in two autism-like mouse models, raising the possibility DBS might be used to treat intractable SIB associated with ASDs. Further studies are required to explore the circuitry engaged by STN-HFS, as well as other potential stimulation sites. Such studies might also yield clues about pathways, which could be modulated by non-invasive stimulatory techniques.
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73
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The role of anxiety in vulnerability for self-injurious behaviour: studies in a rodent model. Behav Brain Res 2016; 311:201-209. [PMID: 27217100 DOI: 10.1016/j.bbr.2016.05.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/19/2016] [Indexed: 12/28/2022]
Abstract
Self-injurious behaviour (SIB) is a debilitating characteristic that is highly prevalent in autism and other neurodevelopmental disorders. Pathological anxiety is also common, and there are reports of comorbid anxiety and self-injury in some children. We have investigated potential interactions between anxiety and self-injury, using a rat model of pemoline-induced self-biting. In one experiment, rats were pre-screened for trait anxiety by measuring expression of anxiety-related behaviour on the elevated plus maze and open field emergence test. The rats were then treated with pemoline once daily for ten days, and vulnerability for pemoline-induced self-injury was evaluated. This revealed modest correlations between innate levels of anxiety-related behaviour in the open field test (time in the start box, and latency to enter the open field), and vulnerability for pemoline-induced self-biting (total duration of self-injurious oral contact, and total size of tissue injury). Measures in the elevated plus maze were not significantly correlated with vulnerability for pemoline-induced self-injury. In a second experiment, rats were treated with the beta-carboline FG 7142 twice daily, during 5days of treatment with pemoline. The rats that were treated with this anxiogenic drug exhibited greater duration of self-injurious oral contact, and larger injuries than vehicle-treated controls did. Overall, these results suggest that anxiety may contribute to the etiology and/or expression of self-injurious behaviour, and indicate that further research is warranted.
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Richards C, Moss J, Nelson L, Oliver C. Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: a prospective cohort study of risk markers. J Neurodev Disord 2016; 8:21. [PMID: 27158272 PMCID: PMC4858900 DOI: 10.1186/s11689-016-9153-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/24/2016] [Indexed: 12/27/2022] Open
Abstract
Background There are few studies documenting the persistence of self-injury in individuals with autism spectrum disorder (ASD) and consequently limited data on behavioural and demographic characteristics associated with persistence. In this longitudinal study, we investigated self-injury in a cohort of individuals with ASD over 3 years to identify behavioural and demographic characteristics associated with persistence. Methods Carers of 67 individuals with ASD (Median age of individuals with ASD in years = 13.5, Interquartile Range = 10.00–17.00), completed questionnaires relating to the presence and topography of self-injury at T1 and three years later at T2. Analyses were conducted to evaluate the persistence of self-injury and to evaluate the behavioural and demographic characteristics associated with persistence of self-injury. Results At T2 self-injurious behaviour had persisted in 77.8 % of individuals. Behavioural correlates of being non-verbal, having lower ability and higher levels of overactivity, impulsivity and repetitive behaviour, were associated with self-injury at both time points. Risk markers of impulsivity (p = 0.021) and deficits in social interaction (p = 0.026) at T1 were associated with the persistence of self-injury over 3 years. Conclusions Impulsivity and deficits in social interaction are associated with persistent self-injury in ASD and thus may act as behavioural risk markers. The identification of these risk markers evidences a role for behaviour dysregulation in the development and maintenance of self-injury. The findings have clinical implications for proactive intervention; these behavioural characteristics may be utilised to identify ‘at risk’ individuals for whom self-injury is likely to be persistent and therefore those individuals for whom early intervention may be most warranted.
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Affiliation(s)
- Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK ; Institute of Psychiatry, King's College London, London, UK
| | - Lisa Nelson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, B15 2TT UK
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75
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Abstract
Self-injury often occurs for the first time in adolescence. The current classification distinguishes several groups: (1) factitious disorder imposed on self and factitious disorder imposed on another, (2) nonsuicidal self-injury (NSSI) and (3) obsessive-compulsive (OCD) and related disorders. The differential diagnosis includes a wide spectrum of psychiatric diseases, including borderline personality disorder (BPD), inherited disorders like Lesch-Nyhan syndrome (LNS) and also body modifications. In all these cases, self-harm is a subphenomenon. This review focuses on typical dermatological pictures.
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76
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Sinha S, McGovern RA, Sheth SA. Deep brain stimulation for severe autism: from pathophysiology to procedure. Neurosurg Focus 2016; 38:E3. [PMID: 26030703 DOI: 10.3171/2015.3.focus1548] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Autism is a heterogeneous neurodevelopmental disorder characterized by early-onset impairment in social interaction and communication and by repetitive, restricted behaviors and interests. Because the degree of impairment may vary, a spectrum of clinical manifestations exists. Severe autism is characterized by complete lack of language development and potentially life-threatening self-injurious behavior, the latter of which may be refractory to medical therapy and devastating for affected individuals and their caretakers. New treatment strategies are therefore needed. Here, the authors propose deep brain stimulation (DBS) of the basolateral nucleus of the amygdala (BLA) as a therapeutic intervention to treat severe autism. The authors review recent developments in the understanding of the pathophysiology of autism. Specifically, they describe the genetic and environmental alterations that affect neurodevelopment. The authors also highlight the resultant microstructural, macrostructural, and functional abnormalities that emerge during brain development, which create a pattern of dysfunctional neural networks involved in socioemotional processing. They then discuss how these findings implicate the BLA as a key node in the pathophysiology of autism and review a reported case of BLA DBS for treatment of severe autism. Much progress has been made in recent years in understanding the pathophysiology of autism. The BLA represents a logical neurosurgical target for treating severe autism. Further study is needed that considers mechanistic and operative challenges.
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Affiliation(s)
- Saurabh Sinha
- 1Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; and
| | - Robert A McGovern
- 2Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- 2Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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77
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Rice LJ, Gray KM, Howlin P, Taffe J, Tonge BJ, Einfeld SL. The Developmental Trajectory of Self-Injurious Behaviours in Individuals with Prader Willi Syndrome, Autism Spectrum Disorder and Intellectual Disability. Diseases 2016; 4:diseases4010009. [PMID: 28933389 PMCID: PMC5456304 DOI: 10.3390/diseases4010009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023] Open
Abstract
In the present study we examined the nature and developmental trajectory of self-injurious behaviour in Prader Willi syndrome (PWS) and autism spectrum disorder (ASD). The development of interventions is greatly aided by understanding gene to behaviour pathways, and this requires an accurate description of the behaviour phenotype, that is, which types and natural history of self-injurious behaviour are more common in PWS and ASD and which are shared with other forms of developmental disability. Self-injury displayed by individuals with PWS and individuals with ASD was compared with that reported in a group of individuals with intellectual disability due to mixed aetiology (ID group). Three self-injurious behaviours (head banging, skin-picking and hitting and/or biting self) were measured on five occasions over 18 years using the Developmental Behaviour Checklist (DBC) a well-validated caregiver report measure. Rates of skin picking were higher in individuals with PWS and hitting and/or biting self was higher in individuals with ASD compared to the ID group. Rates of head banging were similar across the three groups. Over time, skin-picking and head banging increased with age for individuals with ASD and hitting and/or biting self increased for the PWS group. In the PWS and mixed ID groups head banging decreased with age. These findings suggest that the typology and developmental trajectories of self-injurious behaviours differ between those with PWS and ASD.
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Affiliation(s)
- Lauren J Rice
- Brain and Mind Research Centre, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
- Centre for Disability Research and Policy, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
| | - Kylie M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill VIC 3168, Australia.
| | - Patricia Howlin
- Brain and Mind Research Centre, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
- Centre for Disability Research and Policy, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill VIC 3168, Australia.
| | - John Taffe
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill VIC 3168, Australia.
| | - Bruce J Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill VIC 3168, Australia.
| | - Stewart L Einfeld
- Brain and Mind Research Centre, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
- Centre for Disability Research and Policy, University of Sydney, 94 Mallett St, Camperdown NSW 2050, Australia.
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Davies LE, Oliver C. Self-injury, aggression and destruction in children with severe intellectual disability: Incidence, persistence and novel, predictive behavioural risk markers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:291-301. [PMID: 26765248 DOI: 10.1016/j.ridd.2015.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/05/2015] [Accepted: 12/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND A risk informed, early intervention strategy for self-injurious, aggressive and destructive behaviours in children with severe intellectual disability is gaining support. The aims of this study were to establish the cumulative incidence and persistence of self-injury, aggression and destruction and the relationship between these behaviours and two potentially predictive behavioural risk markers (repetitive behaviour, and impulsivity and overactivity) in children at high risk. METHODS In a longitudinal design self-injury, aggression and destruction were assessed by teachers of 417 children with severe intellectual disability on two occasions separated by 15-18 months. RESULTS Aggression, destruction and self-injury were persistent (69%, 57% and 58% respectively). Repetitive and restricted behaviours and interests (RRBI) and overactivity/impulsivity (O/I) were significantly associated with aggression (O/I OR=1.291, p<.001), destruction (RRBI OR 1.201, p=.013; O/I OR 1.278, p<.001) and/or self-injury (RRBI, OR 1.25, p=.004; O/I OR=1.117, p<.001). The relative risk of the cumulative incidence of self-injury, aggression and destruction was significantly increased by repetitive and restricted behaviours and interests (self-injury 2.66, destruction 2.16) and/or overactivity/impulsivity (aggression 2.42, destruction 2.07). CONCLUSIONS The results provide evidence that repetitive and restricted behaviours and interests, and overactivity/impulsivity, are risk markers for the onset of self-injury, aggression and destruction within the already high risk group of children with severe intellectual disability.
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Affiliation(s)
- L E Davies
- Finch Road Primary Care Centre, Finch Road, Lozells, Birmingham B19 1HS, UK
| | - C Oliver
- Cerebra Centre, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Park HR, Lee JM, Moon HE, Lee DS, Kim BN, Kim J, Kim DG, Paek SH. A Short Review on the Current Understanding of Autism Spectrum Disorders. Exp Neurobiol 2016; 25:1-13. [PMID: 26924928 PMCID: PMC4766109 DOI: 10.5607/en.2016.25.1.1] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/18/2015] [Accepted: 12/30/2015] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures in the first 3 years of life. It is not a single disorder, and it is broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Recent developments in neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Especially, the role of amygdala, a major component of the limbic system and the affective loop of the cortico-striatothalamo-cortical circuit, in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. Besides the amygdala, the nucleus accumbens is also considered as the key structure which is related with the social reward response in ASD. Although educational and behavioral treatments have been the mainstay of the management of ASD, pharmacological and interventional treatments have also shown some benefit in subjects with ASD. Also, there have been reports about few patients who experienced improvement after deep brain stimulation, one of the interventional treatments. The key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyo Eun Moon
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jinhyun Kim
- Center for Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
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80
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Ruddick L, Davies L, Bacarese-Hamilton M, Oliver C. Self-injurious, aggressive and destructive behaviour in children with severe intellectual disability: Prevalence, service need and service receipt in the UK. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 45-46:307-315. [PMID: 26296078 DOI: 10.1016/j.ridd.2015.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 06/04/2023]
Abstract
Children with severe intellectual disabilities are at increased risk of presenting with self-injurious, aggressive and destructive behaviour. Severity of these behaviours is an important predictor of psychological and behavioural service use by people with intellectual disabilities. However, studies suggest that the needs of children with intellectual disabilities and their families are not being met. The aims of the present study were to: (1) describe the self-injurious, aggressive and destructive behaviours and subsequent support needs of children with severe intellectual disabilities attending special schools in one major city within the UK, (2) compare teacher and primary carer ratings of behaviour and service need and (3) explore the extent to which the needs of children with intellectual disabilities are being met in terms of contact with relevant specialist services. Questionnaires were completed by teachers and primary family carers of children with a severe intellectual disability. Results indicated that at least 5.3% and 4.1% of children showed at least one behaviour at a clinically significant frequency and management difficulty respectively. Primary carers identified more children with significant behaviour difficulties and support needs than teachers. The odds for children presenting with high levels of the behaviours of interest for having a service need for behavioural intervention were at least 13 times those for children not showing the behaviours, yet only doubled for contact with a specialist relevant health-care professional. These results quantify the magnitude of the substantial gap between level of need and relevant support received.
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Affiliation(s)
- Loraine Ruddick
- Child and Adolescent Mental Health Service: Learning Disability Team, Birmingham Children's Hospital NHS Foundation Trust, 40 Rupert Street, Nechells, Birmingham B7 4PS, UK
| | - Louise Davies
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Monique Bacarese-Hamilton
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Oliver C, Richards C. Practitioner Review: Self-injurious behaviour in children with developmental delay. J Child Psychol Psychiatry 2015; 56:1042-54. [PMID: 25916173 DOI: 10.1111/jcpp.12425] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Self-injurious behaviour is shown by a significant minority of children with developmental delay and has a substantial impact on child and carer wellbeing. Characteristics such as a greater degree of intellectual disability, autism spectrum disorder, some genetic syndromes and repetitive and impulsive behaviours are positively associated with self-injury. Prevalence generally increases with age into midadulthood and the behaviour is notably persistent. SCOPE In this review, we discuss the dominant causal theory of self-injury which draws on the principles of operant learning. We evaluate the utility of this theory to account for all empirical observations of self-injury. FINDINGS A model of self-injury is presented that extends a previous model described by Guess and Carr. The new model integrates child characteristics and operant learning principles in a phenotype × environment paradigm to explain the variance in developmental trajectory of the severity of self-injury. CONCLUSIONS Behaviour dysregulation, as evidenced by the associations between self-injury, self-restraint, repetitive and impulsive behaviours, is identified as potentially influencing the severity and persistence of self-injury. Risk markers for self-injury are identified and the extended model indicates points of intervention and highlights the possibility of risk-related, targeted early intervention. The need for increased training of practitioners in the delivery of demonstrably effective interventions for self-injury is identified.
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Affiliation(s)
- Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, UK
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82
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Kurtz PF, Chin MD, Robinson AN, O'Connor JT, Hagopian LP. Functional analysis and treatment of problem behavior exhibited by children with fragile X syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:150-166. [PMID: 26183339 DOI: 10.1016/j.ridd.2015.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/16/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
The efficacy of function-based interventions for the treatment of severe problem behavior exhibited by individuals with intellectual and developmental disabilities (IDD) is well established. However, few studies have reported on behavioral interventions in fragile X syndrome (FXS) specifically. The present study is a consecutive case-series analysis that reports on functional analysis and treatment of problem behavior of nine children with FXS. Assessment findings were consistent with previous research indicating that among individuals with FXS, problem behavior is more commonly maintained by escape from demands and access to tangible items, relative to the broader population of individuals with IDD. Functional analysis-based behavioral interventions resulted in a mean reduction in problem behavior of 95.2% across the nine participants. Additionally, generalization of treatment effects from controlled clinical settings to home, school, and community was demonstrated. The current findings suggest that function-based behavioral interventions shown to be effective with the broader population of individuals with IDD are also effective for individuals with FXS. Our results in combination with those of previous studies describing functional analysis outcomes provide additional evidence for a unique functional behavioral phenotype for severe problem behavior in individuals with FXS. Implications of study findings for early intervention and prevention of problem behavior in children with FXS are discussed.
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Affiliation(s)
- Patricia F Kurtz
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | | | - Ashley N Robinson
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia T O'Connor
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Louis P Hagopian
- Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Baltimore, MD, United States
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83
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Rattaz C, Michelon C, Baghdadli A. Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:730-740. [PMID: 25583371 DOI: 10.1111/jir.12177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Self-injurious behaviours (SIB) are highly prevalent in individuals with autism spectrum disorders (ASD) and have deleterious effects on the individual and their environment. The aim of this study was to examine SIB prevalence and associated features in a population of 152 adolescents with ASD and to determine risk factors for SIB. METHODS The present study uses a subset of data of a longitudinal follow-up of 152 children with ASD. The presence of a low or high level of self-injury was assessed at adolescence through the Aberrant Behaviour Checklist completed by parents. Clinical and social variables regarding severity of autism symptoms, psychological development, adaptive behaviours, parental quality of life and total intervention time were collected during childhood (mean age = 5 years, SD = 1.6) and at adolescence (mean age = 15 years, SD = 1.3). RESULTS About 35.8% of adolescents with ASD in our sample displayed self-injury, which was frequently associated with other challenging behaviours and was related to severity of autism symptoms, adaptive skills, intellectual functioning and language level (P < 0.001). The main risk factor for SIB at adolescence was severity of autism symptoms (P = 0.04). Cognitive development during childhood was found to be a protective factor (P = 0.03) whereas at adolescence, the main protective factor was communicative abilities (P = 0.04). CONCLUSIONS These data showed that SIB remained highly prevalent at adolescence and yielded risk and protective factors for developing SIB at this period of life. Limitations and perspectives for future research are discussed.
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Affiliation(s)
- C Rattaz
- Centre de Ressources Autisme, CHRU, Montpellier, France
- Université Montpellier, Laboratoire Epsylon, EA 4556
| | - C Michelon
- Centre de Ressources Autisme, CHRU, Montpellier, France
- Université Montpellier, Laboratoire Epsylon, EA 4556
| | - A Baghdadli
- Centre de Ressources Autisme, CHRU, Montpellier, France
- Université Montpellier, Laboratoire Epsylon, EA 4556
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84
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Freeman ZT, Rice KA, Soto PL, Pate KAM, Weed MR, Ator NA, DeLeon IG, Wong DF, Zhou Y, Mankowski JL, Zink MC, Adams RJ, Hutchinson EK. Neurocognitive dysfunction and pharmacological intervention using guanfacine in a rhesus macaque model of self-injurious behavior. Transl Psychiatry 2015; 5:e567. [PMID: 25989141 PMCID: PMC4471292 DOI: 10.1038/tp.2015.61] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/11/2015] [Accepted: 03/24/2015] [Indexed: 11/18/2022] Open
Abstract
Self-injurious behavior (SIB) is a common comorbidity of psychiatric disorders but there is a dearth of information about neurological mechanisms underlying the behavior, and few animal models exist. SIB in humans is characterized by any intentional self-directed behavior that leads to wounds, whereas in macaques it is not always accompanied by wounds. We describe a cohort of rhesus macaques displaying SIB as adults, in which changes within the central nervous system were associated with the SIB. In these macaques, increases in central nervous system striatal dopamine (DA) receptor binding (BPND) measured by positron emission tomography (PET) [11C]raclopride imaging correlated with severity of wounding (rs=0.662, P=0.014). Furthermore, utilizing standardized cognitive function tests, we showed that impulsivity (stop signal reaction time, SSRT) and deficits in attentional set shifting (intra-/extradimensional shift) were correlated with increased severity of SIB (rs=0.563, P=0.045 and rs=0.692, P=0.009, respectively). We also tested the efficacy of guanfacine, an α2A adrenergic agonist that acts to improve postsynaptic transmission of neuronal impulses, in reducing SIB. A subset of these animals were enrolled in a randomized experimenter-blinded study that demonstrated guanfacine decreased the severity of wounding in treated animals compared with vehicle-only-treated controls (P=0.043), with residual beneficial effects seen for several weeks after cessation of therapy. Animals with the highest severity of SIB that received guanfacine also showed the most significant improvement (rs=-0.761, P=0.009). The elevated PET BPND was likely due to low intrasynaptic DA, which in turn may have been improved by guanfacine. With underlying physiology potentially representative of the human condition and the ability to affect outcome measures of disease using pharmacotherapy, this model represents a unique opportunity to further our understanding of the biology and treatment of SIB in both animals and humans.
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Affiliation(s)
- Z T Freeman
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K A Rice
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - P L Soto
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K A M Pate
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M R Weed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - N A Ator
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - I G DeLeon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - D F Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Y Zhou
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J L Mankowski
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M C Zink
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R J Adams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E K Hutchinson
- Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA,Division of Veterinary Resources, National Institutes of Health, 9000 Rockville Pike, Building 14A, Bethesda, MD 21205, USA. E-mail:
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85
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Yıldırım Sarı H, Girli A, Ozturk Ozgonenel S, Rowley H. Determination of Injury Risks and Safety Measures Taken by Mothers of Children With an Intellectual Disability and Autism Spectrum Disorder. Int J Nurs Knowl 2015; 27:95-103. [PMID: 25759189 DOI: 10.1111/2047-3095.12079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study is to determine the injury risk behaviors and home safety measures in children with an intellectual disability or autism spectrum disorder. METHOD The study sample included mothers of 100 children between the ages of 2 and 12 years. FINDINGS There was a significant difference between the home safety measures and the children's ages, the birth order of the children, and the mother's and father's ages. There was not a significant relationship between the children's ages, diagnosis, and Injury Behavior Checklist (IBC). There is a positive correlation between the total score of the Home Safety Measures Control List and IBC.
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Affiliation(s)
- Hatice Yıldırım Sarı
- Health Science Faculty, Nursing Department, Izmir Katip Celebi University, İzmir, Turkey
| | - Alev Girli
- Education Faculty, Special Training Department, Dokuz Eylul University, İzmir, Turkey
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86
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Abstract
BACKGROUND The aim was to gain a UK national sample of people with Rett syndrome (RTT) across the age range and compare their characteristics using a variety of relevant behavioural measures with a well-chosen contrast group. METHODS The achieved sample was 91 girls and women, aged from 4 to 47 years, of whom 71 were known to be MECP2 positive. The contrast group (n = 66), matched for age, gender, language and self-help skills, comprised individuals with six other syndromes associated with intellectual disability. Parental questionnaire measures of RTT specific characteristics, impulsivity, overactivity, mood, interest and pleasure, repetitive behaviour and self-injury were administered. RESULTS Hand stereotypies, breathing irregularities, night-time unrest and anxiety or inappropriate fear were commonly reported among the RTT sample. Problems of low mood were also reported as common. However, mood and interest and pleasure were no lower than found in the contrast group. In addition, self-injury was lower than in the contrast group and was associated with factors found to predict self-injury in other groups of people with severe intellectual disabilities. CONCLUSIONS There is variability in the manifestation of problem behaviours potentially associated with the syndrome across individuals, with some more severely affected in most areas than others. Some of this variability appears to be underpinned by genetic mutation.
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87
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Rubenstein E, Wiggins LD, Lee LC. A Review of the Differences in Developmental, Psychiatric, and Medical Endophenotypes Between Males and Females with Autism Spectrum Disorder. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2015; 27:119-139. [PMID: 26146472 PMCID: PMC4490156 DOI: 10.1007/s10882-014-9397-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Autism spectrum disorder (ASD) is over four times more prevalent in males compared to females. Increased understanding of sex differences in ASD endophenotypes could add insight into possible etiologies and the assessment and management of the disorder. Consequently, the purpose of this review is to describe current literature regarding sex differences in the developmental, psychiatric, and medical endophenotypes of ASD in order to illustrate current knowledge and areas in need of further research. Our review found that repetitive behaviors and restricted interests are more common in males than females with ASD. Intellectual disability is more common in females than males with ASD. Attention to detail may be more common in males than females with ASD and epilepsy may be more common in females than males with ASD, although limited research in these areas prevent definitive conclusions from being drawn. There does not appear to be a sex difference in other developmental, psychiatric, and medical symptoms associated with ASD, or the research was contradictory or too sparse to establish a sex difference. Our review is unique in that it offers detailed discussion of sex differences in three major endophenotypes of ASD. Further research is needed to better understand why sex differences exist in certain ASD traits and to evaluate whether phenotypic sex differences are related to different pathways of development, assessment, and treatment of the disorder.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. MS E-86, Atlanta 30333 GA, USA
| | - Li-Ching Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6032, Baltimore, MD 21205, USA
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Schroeder SR, Marquis JG, Reese RM, Richman DM, Mayo-Ortega L, Oyama-Ganiko R, LeBlanc J, Brady N, Butler MG, Johnson T, Lawrence L. Risk factors for self-injury, aggression, and stereotyped behavior among young children at risk for intellectual and developmental disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 119:351-70. [PMID: 25007299 PMCID: PMC5127691 DOI: 10.1352/1944-7558-119.4.351] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Before the 1990s, research on the early identification and prevention of severe behavior disorders (SBDs), such as aggression, self-injury, and stereotyped behavior, among young children with intellectual and developmental disabilities (IDD), was mostly done with children 3 years or older. More recent work suggests that signs of SBDs may occur as early as 6 months in some infants. The present study combined a cross-sectional and longitudinal approach to examine SBDs in 180 young children aged 4-48 months recruited through mass screening, then receiving an interdisciplinary evaluation and six-month follow-ups for one year. Twelve potential risk factors related to SBDs were examined. Eight of these risk factors, including age, gender, diagnosis, intellectual and communication levels, visual impairment, parent education, family income, were differentially related to scores for Aggression, SIB, and Stereotyped Behavior subscales on the Behavior Problems Inventory (BPI-01) at initial interdisciplinary evaluation. BPI-01 scores decreased over the year for 57% of the children and increased for 43%. The amount of decrease on each BPI-01 subscale varied with age, gender, and diagnosis.
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89
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Eden KE, de Vries PJ, Moss J, Richards C, Oliver C. Self-injury and aggression in tuberous sclerosis complex: cross syndrome comparison and associated risk markers. J Neurodev Disord 2014; 6:10. [PMID: 24822087 PMCID: PMC4017702 DOI: 10.1186/1866-1955-6-10] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/24/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research reporting prevalence rates of self-injurious and aggressive behaviour in people with tuberous sclerosis complex (TSC) is limited. No studies have compared rates of these behaviours in TSC with those in other syndrome groups matched for degree of disability or investigated risk markers for these behaviours in TSC. METHODS Data from the Challenging Behaviour Questionnaire were collected for 37 children, aged 4 to 15 years, with TSC. Odds ratios were used to compare rates of self-injury and aggression in children with TSC with children with idiopathic autism spectrum disorder (ASD), fragile X, Cornelia de Lange and Down syndromes. Characteristics were measured using the Mood Interest and Pleasure Questionnaire, the Activity Questionnaire, the Social Communication Questionnaire, the Repetitive Behaviour Questionnaire, the Wessex Behaviour Schedule and the revised Non-communicating Children Pain Checklist. Mann-Whitney U analyses were used to compare characteristics between individuals with self-injury and aggression and those not showing these behaviours. RESULTS Rates of self-injury and aggression in TSC were 27% and 50%, respectively. These are high but not significantly different from rates in children with Down syndrome or other syndrome groups. Both self-injury and aggression were associated with stereotyped and pain-related behaviours, low mood, hyperactivity, impulsivity and repetitive use of language. Children who engaged in self-injury also had lower levels of interest and pleasure and showed a greater degree of 'insistence on sameness' than children who did not self-injure. Aggression was associated with repetitive behaviour. The majority of these associations remained significant when the association with level of adaptive functioning was controlled for. CONCLUSIONS Behavioural profiles can be used to identify those most at risk of developing self-injury and aggression. Further research is warranted to understand the influence of such internal factors as mood, ASD symptomatology and pain on challenging behaviour in people with intellectual disability.
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Affiliation(s)
- Kate E Eden
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Jo Moss
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17-19 Queen Square, London WC1N 3AR, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
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90
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Marler S, Sanders KB, Veenstra-VanderWeele J. N-acetylcysteine as treatment for self-injurious behavior in a child with autism. J Child Adolesc Psychopharmacol 2014; 24:231-4. [PMID: 24815193 DOI: 10.1089/cap.2013.0137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Sarah Marler
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center , Nashville, Tennessee
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Devine DP. Self-injurious behaviour in autistic children: a neuro-developmental theory of social and environmental isolation. Psychopharmacology (Berl) 2014; 231:979-97. [PMID: 24057764 DOI: 10.1007/s00213-013-3279-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Self-injurious behaviour is not one of the three core symptoms that define autism. However, children on the autism spectrum appear to be particularly vulnerable. Afflicted children typically slap their faces, punch or bang their heads, and bite or pinch themselves. These behaviours can be extremely destructive, and they interfere with normal social and educational activities. However, the neurobiological mechanisms that confer vulnerability in children with autism have not been adequately described. OBJECTIVES This review explores behavioural and neurobiological characteristics of children with autism that may be relevant for an increased understanding of their vulnerability for self-injurious behaviour. METHODS Behavioural characteristics that are co-morbid for self-injurious behaviour in children with autism are examined. In addition, the contributions of social and environmental deprivation in self-injurious institutionalized orphans, isolated rhesus macaques, and additional animal models are reviewed. RESULTS There is extensive evidence that social and environmental deprivation promotes self-injurious behaviour in both humans (including children with autism) and animal models. Moreover, there are multiple lines of convergent neuroanatomical, neurophysiological, and neurochemical data that draw parallels between self-injurious children with autism and environmentally deprived humans and animals. CONCLUSIONS A hypothesis is presented that describes how the core symptoms of autism make these children particularly vulnerable for self-injurious behaviour. Relevant neurodevelopmental pathology is described in cortical, limbic, and basal ganglia brain regions, and additional research is suggested.
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Affiliation(s)
- Darragh P Devine
- Behavioral and Cognitive Neuroscience Program, Department of Psychology, University of Florida, P.O. Box 112250, Gainesville, FL, 32611-2250, USA,
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92
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Doehring P, Reichow B, Palka T, Phillips C, Hagopian L. Behavioral approaches to managing severe problem behaviors in children with autism spectrum and related developmental disorders: a descriptive analysis. Child Adolesc Psychiatr Clin N Am 2014; 23:25-40. [PMID: 24231165 DOI: 10.1016/j.chc.2013.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Severe problem behaviors such as aggression, self-injury, and property destruction can result in injury, and require specialized and expensive treatment. This article reviews outcome research published since 1995 that used behavioral techniques to decrease severe problem behaviors among children and adolescents with autism spectrum disorder and/or intellectual disability. Many relatively simple interventions were reported to significantly reduce severe problem behavior, which offers hope for practitioners. Nonetheless, these studies also reveal a risk for injury and a need for specialized assessment and placement, careful tracking, and high-quality treatment that few agencies could likely replicate without increases in training and support.
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Affiliation(s)
- Peter Doehring
- ASD Roadmap, 5 Nine Gates Road, Chadds Ford, PA 19317, USA.
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93
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Sappok T, Budczies J, Dziobek I, Bölte S, Dosen A, Diefenbacher A. The Missing Link: Delayed Emotional Development Predicts Challenging Behavior in Adults with Intellectual Disability. J Autism Dev Disord 2013; 44:786-800. [DOI: 10.1007/s10803-013-1933-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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94
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Davis TN, Dacus S, Strickland E, Machalicek W, Coviello L. Reduction of automatically maintained self-injurious behavior utilizing noncontingent matched stimuli. Dev Neurorehabil 2013; 16:166-71. [PMID: 23477292 DOI: 10.3109/17518423.2013.766819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Analyze the effects of noncontingent matched stimulation (NMS) on the self-injurious behavior (SIB) of an eight-year-old boy with autism. METHODS First, a functional analysis was conducted to identify the reinforcers maintaining SIB. Next, an informal preference assessment was conducted to identify a potential object to provide safe matched stimulation. A multielement design was implemented to evaluate the effects of two conditions: (a) noncontingent access to attention and unmatched stimulation (DVD player) and (b) intervention consisting of access to NMS. RESULTS Results suggested that NMS resulted in a marked decrease of SIB relative to baseline conditions with unmatched stimulation. CONCLUSIONS Findings suggest that unconventional stimuli may provide stimulation similar to that produced by SIB.
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Affiliation(s)
- Tonya N Davis
- Department of Educational Psychology, Baylor University, Waco, TX 76798-3701, USA.
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95
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Richman DM, Barnard-Brak L, Bosch A, Thompson S, Grubb L, Abby L. Predictors of self-injurious behaviour exhibited by individuals with autism spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:429-439. [PMID: 22998594 DOI: 10.1111/j.1365-2788.2012.01628.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Presence of an autism spectrum disorder is a risk factor for development of self-injurious behaviour (SIB) exhibited by individuals with developmental disorders. The most salient SIB risk factors historically studied within developmental disorders are level of intellectual disability, communication deficits and presence of specific genetic disorders. Recent SIB research has expanded the search for risk factors to include less commonly studied variables for people with developmental disorders: negative affect, hyperactivity and impulsivity. METHOD A heterogeneous sample of 617 individuals with autism spectrum disorder diagnoses was derived from the National Database of Autism Research. Latent constructs were estimated from items of the community version of the Aberrant Behaviour Checklist. Structural equation modelling was used to assess whether impulsivity, hyperactivity, negative affect, severity of stereotypy, intellectual functioning or severity of autism symptoms predicted severity of SIB. RESULTS Impulsivity (β = 0.46), followed by intellectual functioning (β = -0.39), and stereotypy (β = 0.23) were the variables most highly predictive of increased SIB; impulsivity and stereotypy remained significant predictors of SIB after severity of autism symptoms and intelligence quotient (IQ) were controlled for. CONCLUSIONS High levels of impulsivity and stereotypy were significant predictors of SIB in a large and diverse sample of people with confirmed autism diagnoses. Future research is needed on the effects of reducing impulsivity and stereotypy on the outcomes of treatment, early intervention and attempts to prevent the development of SIB.
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Affiliation(s)
- D M Richman
- Burkhart Center for Autism Education and Research, Texas Tech University, Lubbock, TX 79409-1071, USA.
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96
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Toward a better understanding of self injurious behaviors in children and adolescents with autism spectrum disorders. J Autism Dev Disord 2013; 42:2515-8. [PMID: 22798052 DOI: 10.1007/s10803-012-1600-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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97
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Friedman NDB, Warfield ME, Parish SL. Transition to adulthood for individuals with autism spectrum disorder: current issues and future perspectives. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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98
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Moss J, Oliver C, Nelson L, Richards C, Hall S. Delineating the profile of autism spectrum disorder characteristics in Cornelia de Lange and Fragile X syndromes. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 118:55-73. [PMID: 23301903 DOI: 10.1352/1944-7558-118.1.55] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An atypical presentation of autism spectrum disorder is noted in Cornelia de Lange and Fragile X syndromes, but there are few detailed empirical descriptions. Participants in this study were individuals with Cornelia de Lange syndrome (n = 130, M age = 17.19), Fragile X syndrome (n = 182, M age = 16.94), and autism spectrum disorder (n = 142, M age = 15.19), who were comparable on chronological age. Using the Social Communication Questionnaire, the proportion meeting cutoff for autism spectrum disorder and autism was 78.6%, and 45.6%, respectively, in Cornelia de Lange syndrome and 83.6% and 48.6% in Fragile X syndrome. Domain and item analyses indicate differing, atypical autism spectrum disorder profiles in Fragile X and Cornelia de Lange syndromes. A limited association between adaptive behavior and autism spectrum disorder was identified in all groups. The findings have implications for intervention in genetic syndromes and conceptualization of autism spectrum disorder in the wider population.
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Affiliation(s)
- Joanna Moss
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, School of Psychology, Birmingham, Edgbaston, United Kingdom.
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99
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Symons FJ, Devine DP, Oliver C. Self-injurious behaviour in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:421-426. [PMID: 22487005 DOI: 10.1111/j.1365-2788.2012.01553.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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