Treating self-injurious behaviors in autism spectrum disorder

Differences in regional brain structure in toddlers with autism are related to future language outcomes

Language and social symptoms improve with age in some autistic toddlers, but not in others, and such outcome differences are not clearly predictable from clinical scores alone. Here we aim to identify early-age brain alterations in autism that are prognostic of future language ability. Leveraging 372 longitudinal structural MRI scans from 166 autistic toddlers and 109 typical toddlers and controlling for brain size, we find that, compared to typical toddlers, autistic toddlers show differentially larger or thicker temporal and fusiform regions; smaller or thinner inferior frontal lobe and midline structures; larger callosal subregion volume; and smaller cerebellum. Most differences are replicated in an independent cohort of 75 toddlers. These brain alterations improve accuracy for predicting language outcome at 6-month follow-up beyond intake clinical and demographic variables. Temporal, fusiform, and inferior frontal alterations are related to autism symptom severity and cognitive impairments at early intake ages. Among autistic toddlers, brain alterations in social, language and face processing areas enhance the prediction of the child's future language ability.

Applied Behavior Analysis and the Abolitionist Neurodiversity Critique: An Ethical Analysis

The behavior analytic literature on neurodiversity remains limited. This article aims to begin filling the lacuna. We will introduce the neurodiversity perspective and demonstrate an important congruence between the behavior analytic and neurodiversity perspectives on autism. Despite this congruence, applied behavior analysis is often targeted for criticism by proponents of the neurodiversity perspective. A central concern raises questions about the aims of behavior analytic interventions for clients with autism. Is it appropriate to teach clients with autism to behave as if they were neurotypical? Concerns about the aims of behavior analytic interventions mirror concerns that have been raised about the aims of language education in schools. Drawing on the literature regarding linguistically diverse classrooms, we will critically evaluate the abolitionist neurodiversity critique of ABA. We conclude by considering both concrete and theoretical implications for the ethics of behavior analytic work with autistic clients.

Addressing Self-Injurious Behavior in the Medically Complex Child: Identifying the Root Cause vs Blocking Resulting Behavior

Gillian is a 7-year-old nonverbal, internationally adopted girl with significant visual impairment (sees shadows and objects with high contrast), moderate-severe hearing loss, autism spectrum disorder, profound intellectual disability, and a seizure disorder. She resided in an orphanage until age 4 years when she was adopted by her mother. She is referred to the multidisciplinary team in developmental-behavioral pediatrics by her gastroenterologist, who is managing her constipation, for evaluation and management of self-injurious behavior that occurs before bowel movements.Gillian's adoptive mother reported that Gillian has a history of repetitive and self-injurious behavior including hitting her head with the palm of her hand and poking her eyes. The head-hitting behavior has resulted in consistent bruising to her forehead and nasal bridge. The eye poking is of significant concern because of the possibility of resultant injury including corneal abrasion or retinal detachment. Eye poking occurs exclusively during the hour before stooling, at home and school, and is accompanied by screaming, pacing, and increased aggression toward her mother/teachers. Mother typically responds by blocking the eye poking, redirecting Gillian to the toilet, providing prompts to use calming strategies (e.g., deep breathing), or providing sensory input by rubbing her arms/back. Teachers respond in a similar way at school. Gillian's mother has tried to place goggles over Gillian's eyes during eye poking, but this resulted in increased aggressive behaviors.Gillian is not fully bowel trained but will sit on the toilet to urinate when prompted. She completes toilet-sits at home/school 5 to 7 times daily. Gillian passes small, soft bowel movements 2 to 4 times daily on a bowel management regimen consisting of polyethylene glycol 3350 17 grams twice daily and liquid senna 8.8 mg daily. Seizures are reportedly well controlled with an antiepileptic medication managed by her neurologist. Previous medical evaluation by otolaryngology, ophthalmology, neurology, and gastroenterology did not identify a source of pain or other cause for the eye poking. Physical examination reveals normal bowel sounds and a mildly distended abdomen but is otherwise unremarkable. What are your next steps for evaluation and treatment?

Self-reported explanations for self-injury by people with intellectual disabilities: a systematic review of qualitative studies

Background

Emotional distress has received less attention as an explanatory factor for self-injury in people with intellectual disabilities, with research and practice primarily focusing on biobehavioural factors. This systematic review examines the self-reported explanations for self-injury by people with mild or moderate intellectual disabilities, and discusses how the findings contrast with those from self-reported studies of people within the general population who self-harm.

Methods

Five databases (PsychINFO, IBSS, CINAHL, Web of Science and Medline) were systematically searched to find qualitative, empirical research since 2000 about self-reported reasons for self-injury.

Results

Four studies were found which conducted research with people with intellectual disabilities. Three primary themes are discussed: relief from overwhelming emotions; trauma and loss; and difficulty in articulating emotions.

Conclusion

This review found a paucity of research asking people with intellectual disabilities about their own self-injury. However, the research available suggests that explanatory factors for self-injury typically reported in the general population should be considered for those with mild or moderate intellectual disabilities.