Self-injurious behaviour in people with intellectual disability

Professionals' attitudes towards people with intellectual disabilities who self-harm: A literature review

BACKGROUND

National Institute for Health and Care Excellence (NICE, 2013) Guidance on Self-Harm states that professionals supporting people who self-harm should demonstrate compassion, respect and dignity. This literature review examines the evidence for professionals' attitudes towards people with intellectual disabilities who self-harm.

METHOD

Four databases (PsychInfo, IBSS, CINAHL and Medline) were systematically searched to find relevant research since 2000.

RESULTS

Four studies met the criteria. Attitudes of professionals supporting people with intellectual disabilities are contrasted with those of professionals in settings focused on supporting people without intellectual disabilities. Professionals supporting people with intellectual disabilities tended to display attitudes and attributions reflective of biobehavioural and psychosocial theories of self-harm, with a greater emphasis on relationships.

CONCLUSION

Much more research is needed which examines the attitudes of professionals supporting people with intellectual disabilities who self-harm.

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.

Preliminary Development and Testing of the Risk Assessment Checklist for Self-Injury in Autism-Medical (RACSA-M)

Self-injurious behavior (SIB) is a major treatment focus for clinicians treating children with autism spectrum disorder (ASD). A review of the literature identified medical conditions that may be risk factors for an individual engaging in SIB. This study involved the creation and preliminary validation of a standardized assessment checklist: Risk Assessment Checklist for Self-Injury in Autism-Medical (RASCA-M) for the physical, behavioral, and diagnostic evaluation of non-verbal children with autism and SIB living in a residential setting. Preliminary content validity, criterion-related validity, and interobserver agreement were established. The RACSA-M is a promising instrument to assess underlying medical issues in non-verbal children with ASD and SIB.

Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour

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.

Rhesus macaques (Macaca mulatta) with self-injurious behavior show less behavioral anxiety during the human intruder test

Self-injurious behavior (SIB) has been linked to anxiety in the human literature, but relatively few studies have explored this link in rhesus macaques. A widely used behavioral assessment of anxiety, the human intruder test (HIT), employs the mildly stressful stimulus of an unfamiliar experimenter to assess anxious behavior in macaques. The HIT was conducted on 59 (20 male) laboratory housed rhesus macaques, 30 with a record of SIB (10 male). If monkeys with SIB have a more anxious phenotype, they should show stronger reactions to the HIT. However, contrary to our predictions, monkeys with SIB did not show higher levels of anxious behavior compared to controls. They spent significantly less time showing anxious behavior and displayed little aggression in response to the stare of the intruder. SIB and control monkeys did not differ in a range score (number of unique behaviors expressed per phase); however, SIB monkeys had a lower change score (total number of behaviors expressed including repetitions) than controls. In general, monkeys that paced regardless of SIB status, showed a reduction in pacing when the intruder entered the room. Possible explanations for the failure of SIB monkeys to show increased anxiety in the HIT include greater exposure of SIB monkeys to unfamiliar humans because of their condition, evidence for a subtype of SIB which is not anxiety related, and/or the presence of comorbid depressive-like symptoms. Am. J. Primatol. 79:e22569, 2017. © 2016 Wiley Periodicals, Inc.

Autism spectrum disorders: an update on oral health management

Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient.

BACKGROUND

With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders.

METHODS

The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations.

CONCLUSIONS

A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD.