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Shively KB, Tassé MJ. Using a Delphi Process to Update the Nisonger Child Behavior Rating Form. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:455-472. [PMID: 36306412 DOI: 10.1352/1944-7558-127.6.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/28/2021] [Indexed: 06/16/2023]
Abstract
The Nisonger Child Behavior Rating Form (NCBRF) was developed to specifically screen psychopathology and problem behavior in children and adolescents with IDD. This study aimed to update the NCBRF to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and screen for the most prevalent psychopathologies that affect children and adolescents with IDD. The authors re-aligned the existing items to fit within a DSM-5 framework, and then used the Delphi method with a panel of experts in IDD to evaluate the NCBRF items. The revision process included deleting and revising existing items and formulating new items. We obtained a final item pool after three iterations. The Delphi process and resulting item pool are described in this article.
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Affiliation(s)
| | - Marc J Tassé
- Kelsey B. Shively and Marc J. Tassé, The Ohio State University
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2
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Dimian AF, Symons FJ. A systematic review of risk for the development and persistence of self-injurious behavior in intellectual and developmental disabilities. Clin Psychol Rev 2022; 94:102158. [PMID: 35580423 PMCID: PMC10229071 DOI: 10.1016/j.cpr.2022.102158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Self-injurious behavior (SIB) by individuals with intellectual and developmental disabilities including autism (I/DD) is among the most clinically disturbing, socially costly, and scientifically challenging behavior disorders. Forty years of clinical research has produced a knowledge base supporting idiographic behavioral assessment and treatment approaches. Despite the treatment progress, from a public health and population perspective, we argue it is less clear that we have reduced the disorder's burden. The developmental course of the disorder is mostly unknown and empirically informed population-level models of risk are absent. In this review, we systematically examined the published scientific literature specific to risk for SIB in the I/DD population. We reviewed study methodology in detail intentionally informed by an epidemiological perspective with a set of questions intended to test the quality of the inferences about risk. Results are discussed in terms of conceptual, methodological, and translational issues with respect to what needs to be done to create credible and useful clinical models for SIB risk in the I/DD population.
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Affiliation(s)
- Adele F Dimian
- Institute on Community Integration, University of Minnesota(,) Minneapolis, MN, USA.
| | - Frank J Symons
- Dept. of Educational Psychology, University of Minnesota(,) Minneapolis, MN, USA
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3
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Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2130272. [PMID: 34665237 PMCID: PMC8527356 DOI: 10.1001/jamanetworkopen.2021.30272] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Multiple studies have reported that people with autism spectrum disorder (ASD) are at a higher risk for self-injurious behavior and suicide. However, the magnitude of this association varies between studies. OBJECTIVE To appraise the available epidemiologic studies on the risk of self-injurious behavior and suicidality among children and adults with ASD. DATA SOURCES PubMed, Embase, CINAHL, PsycINFO, and Web of Science were systematically searched for epidemiologic studies on the association between ASD and self-injurious behavior and suicidality. Databases were searched from year of inception to April through June 2020. No language, age, or date restrictions were applied. STUDY SELECTION This systematic review and meta-analysis included studies with an observational design and compared self-injurious behavior (defined as nonaccidental behavior resulting in self-inflicted physical injury but without intent of suicide or sexual arousal) and/or suicidality (defined as suicidal ideation, suicide attempt, or suicide) in children (aged <20 years) or adults (aged ≥20 years) with ASD. DATA EXTRACTION AND SYNTHESIS Information on study design, study population, ASD and self-harm definitions, and outcomes were extracted by independent investigators. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% CIs were estimated using DerSimonian-Laird random-effects models. MAIN OUTCOMES AND MEASURES The ORs for the associations of ASD with self-injurious behavior and suicidality were calculated. Analyses were stratified by study setting and age groups as planned a priori. RESULTS The search identified 31 eligible studies, which were of moderate to high quality. Of these studies, 16 (52%) were conducted in children, 13 (42%) in adults, and 2 (6%) in both children and adults. Seventeen studies assessed the association between ASD and self-injurious behavior and reported ORs that ranged from 1.21 to 18.76, resulting in a pooled OR of 3.18 (95% CI, 2.45-4.12). Sixteen studies assessed the association between ASD and suicidality and reported ORs that ranged from 0.86 to 11.10, resulting in a pooled OR of 3.32 (95% CI, 2.60-4.24). In stratified analyses, results were consistent between clinical and nonclinical settings and between children and adults. CONCLUSIONS AND RELEVANCE This study found that ASD was associated with a substantial increase in odds of self-injurious behavior and suicidality in children and adults. Further research is needed to examine the role of primary care screenings, increased access to preventive mental health services, and lethal means counseling in reducing self-harm in this population.
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Affiliation(s)
- Ashley Blanchard
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Carolyn G. DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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4
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Hunsche MC, Saqui S, Mirenda P, Zaidman-Zait A, Bennett T, Duku E, Elsabbagh M, Georgiades S, Smith IM, Szatmari P, Ungar WJ, Vaillancourt T, Waddell C, Zwaigenbaum L, Kerns CM. Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study. J Autism Dev Disord 2020; 50:3496-3509. [PMID: 32034647 DOI: 10.1007/s10803-020-04373-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigated rates of suicidal ideation (SI) and suicidal and/or self-injurious behaviour (SSIB) reported by parents on the Child Behavior Checklist for 178 children with ASD over four annual assessments (ages 7-11 years). Analyses examined the frequency and persistence of SI and SSIB, and the association of SI and SSIB at any time point with child characteristics and internalizing and externalizing problems at age 7. SI occurred in 9.6% of children and was associated with fewer ASD symptoms and better adaptive functioning at age 7. SSIB occurred in 14.6% and was associated with poorer adaptive functioning and more externalizing behaviour at age 7. Internalizing problems were not associated with SI or SSIB at any time point. SI and SSIB rarely co-occurred (4%).
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Affiliation(s)
- Michelle C Hunsche
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Sonja Saqui
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Pat Mirenda
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Anat Zaidman-Zait
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.,Tel Aviv University, Tel Aviv, Israel
| | | | - Eric Duku
- McMaster University, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | - Connor M Kerns
- University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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5
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MacLean WE, Damian AF, Hoch J, Tervo RT, Symons FJ. Comparative analysis of self-injurious behaviour topographies in young children with and without developmental delay. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:673-680. [PMID: 32643272 PMCID: PMC8212423 DOI: 10.1111/jir.12758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND The present study presents post hoc analyses of specific topographies of self-injurious behaviour (SIB) exhibited by young children with developmental delay (DD) and children with typical development (TD). We conducted these analyses to better understand similarities and differences between the groups from a developmental perspective. No previous study has compared the prevalence, severity and co-occurrence of specific topographies of SIB in young children. METHOD The participants were parents of two groups of children one with DD (n = 49, mean age = 37.5 months) and one with TD (n = 49, mean age = 36.6 months). Individual items of the SIB subscale from the Repetitive Behaviour Scale-Revised were used in the analyses. RESULTS Seven of the eight Repetitive Behaviour Scale-Revised SIB categories were reported for both groups. Children in the DD group were significantly more likely to engage in Hits Self against Surface or Object, Hits Self with Body Part, Inserts Finger or Object, Skin Picking and Bites Self. Parental ratings of severity were also significantly greater for the DD group for these five topographies. The DD group engaged in a significantly greater number of SIB topographies than the children in the TD group. Children in the TD group were more likely to exhibit a single SIB topography while the DD group were more likely to engage in two or more topographies. Topographies involving self-hitting were not only more frequent among the children in the DD group but also more likely to be rated as moderate or severe in nature. CONCLUSIONS Compared with the TD group, the topographies of SIB exhibited by the DD group were more prevalent, more severe and co-occurred with greater frequency. Inclusion of a group of children with TD provided an important comparative context for the occurrence of SIB in children with DD.
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Associated Factors of Self-injury Among Adolescents with Autism Spectrum Disorder in a Community and Residential Treatment Setting. J Autism Dev Disord 2020; 50:2987-3004. [PMID: 32056114 DOI: 10.1007/s10803-020-04389-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-injurious behavior (SIB) occurs in up to 50% of individuals with autism. As one of the most serious conditions in individuals with developmental disabilities, SIB affects the individual and his or her family in multiple contexts. A systematic analysis of factors most commonly associated with SIB could inform the development of individualized intervention strategies. The current study examined factors related to SIB in an analysis of client records of 145 children with autism in a comprehensive care center. Predictor variables included age, gender, the Adaptive Behavior Composite, sensory processing, aggression, stereotypies, irritability, adaptive skills, and medical conditions. Age, irritability, and the Adaptive Behavior Composite were found to significantly predict SIB.
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7
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Schaffler MD, Middleton LJ, Abdus-Saboor I. Mechanisms of Tactile Sensory Phenotypes in Autism: Current Understanding and Future Directions for Research. Curr Psychiatry Rep 2019; 21:134. [PMID: 31807945 PMCID: PMC6900204 DOI: 10.1007/s11920-019-1122-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current body of behavioral, physiological, and molecular knowledge concerning tactile sensitivity in autism spectrum disorder (ASD), with a focus on recent studies utilizing rodent models. RECENT FINDINGS Mice with mutations in the ASD-related genes, Shank3, Fmr1, UBE3A, and Mecp2, display tactile abnormalities. Some of these abnormalities appear to be caused by mutation-related changes in the PNS, as opposed to changes in the processing of touch stimuli in the CNS, as previously thought. There is also growing evidence suggesting that peripheral mechanisms may contribute to some of the core symptoms and common comorbidities of ASD. Researchers are therefore beginning to assess the therapeutic potential of targeting the PNS in treating some of the core symptoms of ASD. Sensory abnormalities are common in rodent models of ASD. There is growing evidence that sensory hypersensitivity, especially tactile sensitivity, may contribute to social deficits and other autism-related behaviors.
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Affiliation(s)
| | - Leah J. Middleton
- Department of Biology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Ishmail Abdus-Saboor
- Department of Biology, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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8
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Sener EF, Taheri S, Sahin MC, Bayramov KK, Marasli MK, Zararsiz G, Mehmetbeyoglu E, Oztop DB, Canpolat M, Canatan H, Ozkul Y. Altered Global mRNA Expressions of Pain and Aggression Related Genes in the Blood of Children with Autism Spectrum Disorders. J Mol Neurosci 2018; 67:89-96. [PMID: 30519864 DOI: 10.1007/s12031-018-1213-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/11/2018] [Indexed: 12/28/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by repetitive stereotypic behaviors, restricted interests, social withdrawal, and communication deficits. Aggression and insensitivity to pain are largely unexplained in these cases. We analyzed nine mRNA expressions of the candidate genes related to aggression and insensitivity to pain in the peripheral blood of patients with ASD. Whole blood samples were obtained from 40 autistic patients (33 boys, 7 girls) and 50 age- and sex-matched controls (37 boys and 13 girls) to isolate RNA. Gene expression was assessed by quantitative Real-Time PCR (qRT-PCR) in the Erciyes University Genome and Stem Cell Center (GENKOK). All of the gene expressions except CRHR1 and SLC6A4 were found to be statistically different between the ASD patients and controls. Gene expression also differed according to gender. Alterations in the mRNA expression patterns of the HTR1E, OPRL1, OPRM1, TACR1, PRKG1, SCN9A and DRD4 genes provide further evidence for a relevant effect of the respective candidate genes on the pathophysiology of ASD. Future studies may determine the sensitivity of these candidate markers in larger samples including further neuropsychiatric diagnosis.
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MESH Headings
- Aggression
- Autism Spectrum Disorder/blood
- Autism Spectrum Disorder/genetics
- Autism Spectrum Disorder/physiopathology
- Biomarkers/blood
- Child, Preschool
- Cyclic GMP-Dependent Protein Kinase Type I/genetics
- Cyclic GMP-Dependent Protein Kinase Type I/metabolism
- Female
- Humans
- Male
- NAV1.7 Voltage-Gated Sodium Channel/genetics
- NAV1.7 Voltage-Gated Sodium Channel/metabolism
- Pain Perception
- RNA, Messenger/blood
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptor, Serotonin, 5-HT1A/genetics
- Receptor, Serotonin, 5-HT1A/metabolism
- Receptors, Dopamine D4/genetics
- Receptors, Dopamine D4/metabolism
- Receptors, Opioid/genetics
- Receptors, Opioid/metabolism
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Affiliation(s)
- Elif Funda Sener
- Department of Medical Biology, Erciyes University Medical Faculty , 38039, Kayseri, Turkey.
- Erciyes University Genome and Stem Cell Center (GENKOK), 38039, Kayseri, Turkey.
| | - Serpil Taheri
- Department of Medical Biology, Erciyes University Medical Faculty , 38039, Kayseri, Turkey
- Erciyes University Genome and Stem Cell Center (GENKOK), 38039, Kayseri, Turkey
| | | | | | | | - Gokmen Zararsiz
- Department of Biostatistics, Erciyes University Medical Faculty , 38039, Kayseri, Turkey
| | - Ecmel Mehmetbeyoglu
- Department of Medical Biology, Erciyes University Medical Faculty , 38039, Kayseri, Turkey
- Erciyes University Genome and Stem Cell Center (GENKOK), 38039, Kayseri, Turkey
| | - Didem Behice Oztop
- Department of Child and Adolescent Psychiatry, Ankara University Medical Faculty , Ankara, Turkey
| | - Mehmet Canpolat
- Department of Child Neurology, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Halit Canatan
- Department of Medical Biology, Erciyes University Medical Faculty , 38039, Kayseri, Turkey
| | - Yusuf Ozkul
- Department of Medical Genetics, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
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9
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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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10
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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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11
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Stanwicks LL, Hamel AF, Novak MA. Rhesus macaques ( Macaca mulatta) displaying self-injurious behavior show more sleep disruption than controls. Appl Anim Behav Sci 2017; 197:62-67. [PMID: 29276322 DOI: 10.1016/j.applanim.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Self-injurious behavior (SIB) is a pathology observed in both humans and animals. In humans, SIB has been linked to various mental health conditions that are also associated with significant sleep disruption. In rhesus macaques, SIB consists of self-directed biting which can range from mild skin abrasions to wounds requiring veterinary care. However, only one study suggests possible sleep disruption in macaques with SIB. We evaluated sleep disruption using a noninvasive system (infra-red camera and a video surveillance program) which created videos for every movement over the nighttime hours. Nighttime activity was examined in 13 macaques (three females) of which six were classified as having SIB (one female). Each monkey was studied for a total of 6 nights spanning a period of 4 months. Measures included total movement time (TMT), time moving in the first hour (HR1), time moving in the last hour (HR11), and number of videos <10 secs, ≥10 secs, and ≥30 secs in length. Overall, SIB monkeys had higher TMT (p < 0.01), higher HR1 (p<0.001), and generated more videos ≥10 secs (p < 0.01) and ≥30 secs (p < 0.01). Thus, SIB monkeys showed significant sleep disruption. A four-fold difference between SIB and control monkeys in the ≥30 secs videos revealed many more significant awakenings in the SIB group. Overall higher nighttime activity, in the first hour but not in the last hour, is consistent with sleep-onset insomnia in humans. Whether increased nighttime activity contributes to the SIB condition during the day or, conversely, SIB causes higher nighttime activity remains undetermined.
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Affiliation(s)
- Lauren L Stanwicks
- Department of Psychological and Brain Sciences, Tobin Hall, 135 Hicks Way, University of Massachusetts Amherst, Amherst, MA. 01003
| | - Amanda F Hamel
- Department of Psychological and Brain Sciences, Tobin Hall, 135 Hicks Way, University of Massachusetts Amherst, Amherst, MA. 01003
| | - Melinda A Novak
- Department of Psychological and Brain Sciences, Tobin Hall, 135 Hicks Way, University of Massachusetts Amherst, Amherst, MA. 01003
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12
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Sener EF, Sahin MC, Taheri S, Bayramov KK, Marasli MK, Zararsiz G, Canpolat M, Sahin N, Oztop DB. A preliminary study of the genes related to aggression and insensitivity to pain in autism spectrum disorders. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1293248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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13
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Courtemanche AB, Black WR, Reese RM. The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:194-203. [PMID: 27119211 DOI: 10.1352/1944-7558-121.3.194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain, which contradicts previous assertions of blunted pain sensitivity in this population. The purpose of this study was to measure expressions of pain among young children being evaluated for autism and other neurodevelopmental disabilities. The frequency of pain-related behaviors was assessed during everyday routines using the Non-Communicating Children's Pain Checklist (NCCPC-R) for 51 children. Significant group differences between children with and without self-injury were found for the NCCPC-R total scores. The frequency and severity of self-injury, aggression, and stereotypy were also highly correlated with the total scores on the NCCPC-R. These results continue to support that individuals with self-injury may have enhanced expressions of pain.
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14
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Minshawi NF, Hurwitz S, Morriss D, McDougle CJ. Multidisciplinary assessment and treatment of self-injurious behavior in autism spectrum disorder and intellectual disability: integration of psychological and biological theory and approach. J Autism Dev Disord 2015; 45:1541-68. [PMID: 25395094 DOI: 10.1007/s10803-014-2307-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The objective of this review is to consider the psychological (largely behavioral) and biological [neurochemical, medical (including genetic), and pharmacological] theories and approaches that contribute to current thinking about the etiology and treatment of self-injurious behavior (SIB) in individuals with autism spectrum disorder and/or intellectual disability. Algorithms for the assessment and treatment of SIB in this context, respectively, from a multidisciplinary, integrative perspective are proposed and challenges and opportunities that exist in clinical and research settings are discussed.
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Affiliation(s)
- Noha F Minshawi
- Christian Sarkine Autism Treatment Center, James Whitcomb Riley Hospital for Children, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Symons FJ, Tervo RC, Barney CC, Damerow J, Selim M, McAdams B, Foster S, Crabb GW, Kennedy W. Peripheral Innervation in Children With Global Developmental Delay: Biomarker for Risk for Self-Injurious Behavior? J Child Neurol 2015; 30:1722-7. [PMID: 25918119 PMCID: PMC4610824 DOI: 10.1177/0883073815579704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/07/2015] [Indexed: 02/02/2023]
Abstract
The relation between somatosensory mechanisms and self-injury among children with neurologic impairments associated with developmental delay is not well understood. We evaluated the feasibility of procuring skin biopsies to examine epidermal nerve fiber density and reported self-injury. Following informed parental consent, epidermal skin biopsies were obtained from a distal leg site with no pre-existing skin damage from 11 children with global developmental delay (55% male; mean age = 36.8 months, 17-63 months). Visual microscopic examination and quantitative analyses showed extremely high epidermal nerve fiber density values for some children. Children with reported self-injury (5/11) had significantly (P < .02) greater density values (138.8, standard deviation = 45.5) than children without self-injury (80.5, standard deviation = 17.5). Results from this novel immunohistologic analysis of skin in very young children with neurodevelopmental delays suggest it may be a useful tool to study peripheral innervation as a possible sensory risk factor for self-injury.
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Affiliation(s)
- Frank J. Symons
- Department of Educational Psychology, 56 East River Road, University of Minnesota, Minneapolis, MN 55455
| | | | - Chantel C. Barney
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, MN 55101
| | - John Damerow
- Department of Educational Psychology, 56 East River Road, University of Minnesota, Minneapolis, MN 55455
| | - Mona Selim
- University of Minnesota, Peripheral Nerve Lab, MMC 187, 420 Delaware St. SE, Minneapolis MN 55455
| | - Brian McAdams
- University of Minnesota, Peripheral Nerve Lab, MMC 187, 420 Delaware St. SE, Minneapolis MN 55455
| | - Shawn Foster
- University of Minnesota, Peripheral Nerve Lab, MMC 187, 420 Delaware St. SE, Minneapolis MN 55455
| | - Gwen Wendelschafer Crabb
- University of Minnesota, Peripheral Nerve Lab, MMC 187, 420 Delaware St. SE, Minneapolis MN 55455
| | - William Kennedy
- University of Minnesota, Peripheral Nerve Lab, MMC 187, 420 Delaware St. SE, Minneapolis MN 55455
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Hoch J, Spofford L, Dimian A, Tervo R, MacLean WE, Symons FJ. A Direct Comparison of Self-Injurious and Stereotyped Motor Behavior Between Preschool-Aged Children With and Without Developmental Delays. J Pediatr Psychol 2015; 41:566-72. [PMID: 26514642 DOI: 10.1093/jpepsy/jsv102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/06/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare the prevalence of self-injurious behavior (SIB) and stereotyped motor behavior (STY) of preschool-aged children with developmental delays (DD group) and their peers without developmental delays (TD group) using a standardized caregiver report scale. METHODS The Repetitive Behavior Scale-Revised was completed by caregivers of children with developmental delays and their peers without developmental delays. Frequency of occurrence and severity ratings for SIB and STY were compared between groups. RESULTS SIB and STY were reported more often and at a greater level of severity in the DD group. Older chronological age was associated with more severe STY in the DD group but not the TD group. Gender was not related to STY or SIB for either group. CONCLUSIONS Differences in STY and SIB were evident between preschoolers with and without DD. Findings are discussed from developmental and behavioral psychology perspectives regarding the expression of repetitive behavior in developmentally at-risk pediatric populations.
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Westlund Schreiner M, Klimes-Dougan B, Begnel ED, Cullen KR. Conceptualizing the neurobiology of non-suicidal self-injury from the perspective of the Research Domain Criteria Project. Neurosci Biobehav Rev 2015; 57:381-91. [PMID: 26424412 DOI: 10.1016/j.neubiorev.2015.09.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 12/30/2022]
Abstract
Non-suicidal self-injury (NSSI) commonly starts in adolescence and is associated with an array of negative outcomes. Neurobiological research investigating NSSI is in its early stages and most studies have examined this behavior within the context of specific diagnoses. However, the Research Domain Criteria (RDoC) initiative encourages researchers to examine brain-behavior relationships across diagnoses. This review on the neurobiology associated with NSSI is organized using the domains proposed by RDoC: Negative Valence, Positive Valence, Cognitive, Social Processes, and Arousal/Regulatory Systems. Evidence of neurobiological anomalies is found in each of these domains. We also propose future research directions, especially in regard to human development. Future NSSI studies should address this behavior independent of diagnosis, examine relevant constructs across multiple units of analysis, and assess how systems change across development and course of illness. These advances will be essential for guiding neurobiologically informed intervention and prevention strategies to target NSSI. In doing so, we may prevent the associated negative outcomes across the lifespan.
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Affiliation(s)
- Melinda Westlund Schreiner
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455, United States.
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455, United States.
| | - Erin D Begnel
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Road, Minneapolis, MN 55455, United States.
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota Medical School, F268 West Building, 2450 Riverside Avenue, Minneapolis, MN 55454, United States.
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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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19
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Allely CS. Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder. ScientificWorldJournal 2013; 2013:916178. [PMID: 23843740 PMCID: PMC3697411 DOI: 10.1155/2013/916178] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 04/30/2013] [Indexed: 12/25/2022] Open
Abstract
The peer-reviewed literature investigating the relationship between pain expression and perception of pain in individuals with ASD is sparse. The aim of the present systematic PRIMSA review was twofold: first, to see what evidence there is for the widely held belief that individuals with ASD are insensitive to pain or have a high pain threshold in the peer-reviewed literature and, second, to examine whether individuals with ASD react or express pain differently. Fifteen studies investigating pain in individuals with ASD were identified. The case studies all reported pain insensitivity in individuals with ASD. However, the majority of the ten experimental studies reviewed indicate that the idea that individuals with ASD are pain insensitive needs to be challenged. The findings also highlight the strong possibility that not all children with ASD express their physical discomfort in the same way as a neurotypical child would (i.e., cry, moan, seek comfort, etc.) which may lead caregivers and the medical profession to interpret this as pain insensitivity or incorrectly lead them to believe that the child is in no pain. These results have important implications for the assessment and management of pain in children with ASD.
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Affiliation(s)
- C S Allely
- Institute of Health and Wellbeing, University of Glasgow, RHSC Yorkhill, Glasgow G3 8SJ, UK.
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20
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Duerden EG, Oatley HK, Mak-Fan KM, McGrath PA, Taylor MJ, Szatmari P, Roberts SW. Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. J Autism Dev Disord 2013; 42:2460-70. [PMID: 22422338 DOI: 10.1007/s10803-012-1497-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal functional communication; (d) abnormal social functioning; (e) age; (f) the need for sameness; (g) rituals and compulsions. Half (52.3%, n = 126) of the children (n = 241, aged 2-19 years) demonstrated SIB. Abnormal sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Since atypical sensory processing and sameness have a greater relative impact on SIB, treatment approaches that focus on these factors may be beneficial in reducing self-harm in children with ASD.
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Affiliation(s)
- Emma G Duerden
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
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21
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Socioeconomic deprivation and associated risk factors of traumatic brain injury in children. J Trauma Acute Care Surg 2012; 73:1327-31. [DOI: 10.1097/ta.0b013e31826fc87f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Furniss F, Biswas AB. Recent research on aetiology, development and phenomenology of self-injurious behaviour in people with intellectual disabilities: a systematic review and implications for treatment. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:453-475. [PMID: 22369696 DOI: 10.1111/j.1365-2788.2012.01534.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Behavioural interventions conceptualise self-injurious behaviour (SIB) as developing from early repetitive behaviours through acquisition of homeostatic functions in regulating stimulation and subsequent shaping into SIB through socially mediated or automatic operant reinforcement. Despite high success rates, such interventions rarely completely eliminate SIB, and overall effectiveness has not increased since the 1960s. METHODS Research (excluding studies of single genetic syndromes) on the early development, functional properties and phenomenology of SIB in persons with intellectual disabilities (IDs) published from 1999 to 2010 inclusive is reviewed. RESULTS Despite evidence to support the operant shaping hypothesis, in some cases tissue-damaging SIB, especially head-banging, emerges at a similar or younger age than stereotyped behaviours or 'proto-SIB', often associated with tantrums following frustrative non-reward and/or abrupt situational transitions. Many young children show undifferentiated patterns of responding in functional analyses of SIB, and SIB is associated with aggression and impulsivity as well as with repetitive behaviour. CONCLUSIONS One dynamic in the development of SIB may be Pavlovian conditioning of aggression, originally elicited by aversive events or frustrative non-reward, to stimuli associated with such situations. Integration into operant technology of interventions based on Pavlovian principles such as graduated exposure (with or without counterconditioning) to aversive stimuli may enhance the effectiveness of behavioural interventions.
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Schroeder SR, Courtemanche A. Early Prevention of Severe Neurodevelopmental Behavior Disorders: An Integration. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2012; 5:203-214. [PMID: 23139733 PMCID: PMC3489482 DOI: 10.1080/19315864.2011.593697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There is a very substantial literature over the past 50 years on the advantages of early detection and intervention on the cognitive, communicative, and social-emotional development of infants and toddlers at risk for developmental delay due to premature birth or social disadvantage. Most of these studies excluded children with severe delays or other predisposing conditions, such as genetic or brain disorders. Many studies of children with biological or socio-developmental risk suggest that behavior disorders appear as early as three years and persist into adulthood if not effectively treated. By contrast, little is known about the infants and toddlers with established risk for severe delays, who make up a significant proportion of the population with dual diagnoses later in life.In the past decade, there has been a growing interest in early detection and intervention with children aged birth to three years, e.g. the P.L.99-457, Part C Birth-Three population, who may have disabilities and severe behavior problems, e.g. aggression, self-injury, and repetitive stereotyped behaviors. The available research is scattered in the behavior analytic literature, in the child development literature, as well as in the child mental health and psychiatry literature, the developmental disability literature, the animal modeling literature, and the genetics literature. The goal of this introductory overview is to integrate these literatures, by cross-referencing members of these various groups who have worked in this field, in order to provide the reader with an integrated picture of what is known and of future directions that need more research.
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Kurtz PF, Chin MD, Huete JM, Cataldo MF. Identification of Emerging Self-Injurious Behavior in Young Children: A Preliminary Study. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2012; 5:260-285. [PMID: 22844389 PMCID: PMC3404746 DOI: 10.1080/19315864.2011.600809] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Self-injurious behavior (SIB) is a chronic disorder that often begins in early childhood; however, few studies have examined the onset of SIB in young children. This preliminary study reports on the identification, assessment and observation of SIB in 32 children who had begun to engage in SIB within the previous 6 months. Participants were ages birth to 5 years and presented with or were at risk for intellectual and/or developmental disabilities. Assessment measures included parental interviews, developmental and language measures, standardized measures of problem behavior, and direct observations conducted in the home. Results indicated that for most children, SIB emerged prior to age 1 year, and multiple topographies of SIB and other problem behaviors developed in most children. Multiple measures were useful in identifying SIB and in characterizing the behavior by topography, frequency, and severity. Findings from the examination of child communication in relation to SIB were inconclusive. Results are discussed in relation to theories of SIB emergence, and previous observational studies of young children with SIB.
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Affiliation(s)
- Patricia F Kurtz
- Kennedy Krieger Institute and The Johns Hopkins University School of Medicine
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Mayo-Ortega L, Oyama-Ganiko R, Leblanc J, Schroeder SR, Brady N, Butler MG, Reese RM, Richman DM, Peacock G, Foster J, Marquis J. Mass Screening for Severe Problem Behavior among Infants and Toddlers In Peru. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2012; 5:246-259. [PMID: 22962573 PMCID: PMC3433073 DOI: 10.1080/19315864.2011.590626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION: Severe behavior problems among people with intellectual and developmental disabilities (IDD) are a major barrier to integration in the community. Recent research suggests that these behaviors often begin very early in life and might be prevented by early identification and intervention (Rojahn, Schroeder, & Hoch, 2008). The current paper presents a method of mass screening for early signs of severe behavior problems among infants and toddlers in Peru. METHODS: A Parental Concerns Questionnaire (PCQ) which asks 15 questions, each related to a risk factor for severe behavior problems, based on past research on IDD, was used by veteran parents to interview 341 new parents who had been solicited by TV, radio, and public service announcements across the country. Of these, 262 were recruited and enrolled in a longitudinal study in which they will be followed for 12 months, to see if at-risk children actually will develop severe behavior problems. An extensive initial interdisciplinary evaluation was given to each child. Consumer satisfaction questionnaires were given to the parents as to their attitude toward the screening method. RESULTS: Data from the Interdisciplinary Evaluations of the sample suggest a very high hit rate (96%) by the screening instrument (PCQ). Consumer satisfaction was 98%, suggesting that the method was tolerated well by parents. DISCUSSION: The PCQ is a brief and efficient method to screen infants and toddlers at risk for severe behavior problems. The data also suggest that parents suspect these problems at a very early age. Early intervention thus seems a feasible strategy to intervene before these problems become deeply ingrained as children develop.
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