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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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2
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Deb S, Akrout Brizard B, Limbu B. Association between epilepsy and challenging behaviour in adults with intellectual disabilities: systematic review and meta-analysis. BJPsych Open 2020; 6:e114. [PMID: 32972481 PMCID: PMC7576663 DOI: 10.1192/bjo.2020.96] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous systematic reviews showed no significant association between epilepsy and challenging behaviours in adults with intellectual disabilities. AIMS To identify whether there is an association between epilepsy and challenging behaviour in adults with intellectual disabilities by carrying out a systematic review of published data. PROSPERO registration number: CRD42020178092. METHOD We searched five databases and hand-searched six journals. Two authors independently screened titles, abstracts and full articles using a standardised eligibility checklist. Several meta-analyses were carried out. RESULTS The narrative analysis of data from 34 included articles (14 168 adults with intellectual disabilities, 4781 of whom also had epilepsy) showed no significant association between epilepsy and challenging behaviour. Meta-analysis was possible on data from 16 controlled studies. This showed no significant intergroup difference but after sensitivity analysis meta-analysis of 10 studies showed a significantly higher rate of overall challenging behaviour in the epilepsy group (effect size: 0.16) compared with the non-epilepsy group. Aggression and self-injurious behaviour both showed a statistically significant higher rate in the epilepsy group, with very small effect sizes (0.16 and 0.28 respectively). No significant intergroup difference was observed in the rate of stereotypy. CONCLUSIONS The findings are contradictory and must be interpreted with caution because of the difficulty in pooling data from varied studies, which is likely to introduce confounding. Where significant differences were found, effect sizes are small and may not be clinically significant, and there are major methodological flaws in the included studies, which should be addressed in future large-scale properly controlled studies.
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Affiliation(s)
- Shoumitro Deb
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
| | - Basma Akrout Brizard
- Institut de Psychologie, Laboratoire de Psychopathologie et Processus de Santé, Paris, France
| | - Bharati Limbu
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, UK
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3
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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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4
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Eng B, Addison P, Ring H. A guide to intellectual disability psychiatry assessments in the
community. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.113.011213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryPsychiatric assessment in the community is an important part of both the
initial assessment process and delivery of follow-up care in adult
intellectual disability services in the UK. This article examines how such
assessments can be carried out safely and explores the clinical skills
required to perform them effectively. Use of the psychiatric interview and
mental state examination to elicit information is discussed. Communication
difficulties experienced by people with intellectual disabilities and
strategies that may be employed to address these in the assessment process
are also explored. The article is directed at psychiatrists, in particular
specialty trainees, and other healthcare professionals who work with
intellectually disabled people.
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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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6
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Antelmi E, Plazzi G, Erro R, Tinuper P, Balint B, Liguori R, Bhatia KP. Intermittent head drops: the differential spectrum. J Neurol Neurosurg Psychiatry 2016; 87:414-9. [PMID: 26085650 DOI: 10.1136/jnnp-2015-310864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/27/2015] [Indexed: 01/18/2023]
Abstract
Intermittent Head Drops are episodic head flexion movements that can occur in a number of conditions. Typically, the term has mainly been related to epileptic episodes, but the spectrum of clinical conditions associated with this feature is wide-ranging even if never discussed in detail. By searching the electronic database, we may find that apart from the epileptic conditions, Intermittent Head Drops have been in fact reported in the setting of movement disorders, sleep disorders and even internal medicine disorders, such as Sandifer syndrome. We render an in-depth description of this characteristic phenomenon in different diseases, describing the clinical clues and neurophysiological patterns that may help the clinician to distinguish between the different settings of occurrence.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Bettina Balint
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK
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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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8
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Polskaya N. Self-injurious acts in patients with bordeline personality disorders. EXPERIMENTAL PSYCHOLOGY (RUSSIA) 2015. [DOI: 10.17759/exppsy.2015080312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Results of the empirical study on the relation between emotion regulation factors and the peculiarity of self-injurious behavior in clinical and nonclinical groups are reported. Participants of the research (N=68) comprised two groups: inpatients with borderline personality disorders (N=33; М=44,9, SD=10,8) and control group (N=35; M=39,3, SD=11,2). Methods: the scale of reasons for self-injurious behavior (Polskaya, 2014), Cognitive Emotion Regulation Questionnaire (Garnefski et al., 2002, Rasskazova et al., 2011), the Ways of Coping Questionnaire (Lazarus, Folkman, 1988, Kryukova, Kuftyak, 2004) and Emotional Intelligence questionnaire (Lyusin, 2009). Conclusion: 1) self-injuries are observed both in clinical and nonclinical group; in patients with borderline personality disorders they are related to a certain mental state and/or a wish to change it, whereas in control group self-injuries possess a reactive character; 2) such strategies of cognitive emotion regulation as decreased ability to plan, rumination and catastrophizing, can be regarded as markers of self-injurious behavior; 3) self-injury in patients with borderline personality disorders is related to decreased understanding of emotion, whereas in control group it is related to emotion management and expression; 4) self-injury can execute antisuicidal function and be reinforced by constructive strategies of emotion regulation in the structure of coping behavior or defense mechanisms.
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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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10
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Powis L, Oliver C. The prevalence of aggression in genetic syndromes: a review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:1051-1071. [PMID: 24594523 DOI: 10.1016/j.ridd.2014.01.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
Research into behavioural phenotypes identifies both environmental and organic factors as influencing aggression in children and adults with genetic disorders associated with intellectual disability. However, in contrast to self-injury there is a paucity of research that compares aggression across relevant syndromes. The primary aim of this review is to examine the association between aggression and genetic syndromes by analysis of prevalence studies. The review also examines the literature on the form of the behaviour and influence of environmental factors. Results imply that certain syndrome groups (Cri du Chat, Smith-Magenis, Prader-Willi, Angelman, Cornelia de Lange, and Fragile X syndromes; estimates over 70%) evidence a stronger association with aggression than others (e.g. Williams and Down syndromes; estimates below 15%). However, the strength of association is difficult to quantify due to methodological differences between studies. The results from examining form and environmental influences highlight the importance of phenotype-environment interactions. Research employing group comparison designs is warranted and future work on the assessment and intervention of aggression in genetic syndromes should consider the importance of phenotype-environment interactions.
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Affiliation(s)
- Laurie Powis
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Chris Oliver
- The Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham B15 2TT, UK.
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Didden R, Sturmey P, Sigafoos J, Lang R, O’Reilly MF, Lancioni GE. Nature, Prevalence, and Characteristics of Challenging Behavior. FUNCTIONAL ASSESSMENT FOR CHALLENGING BEHAVIORS 2012. [DOI: 10.1007/978-1-4614-3037-7_3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Taylor L, Oliver C, Murphy G. The Chronicity of Self-Injurious Behaviour: A Long-Term Follow-Up of a Total Population Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1468-3148.2010.00579.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Schneider SA, Lang AE, Moro E, Bader B, Danek A, Bhatia KP. Characteristic head drops and axial extension in advanced chorea-acanthocytosis. Mov Disord 2010; 25:1487-91. [PMID: 20544815 DOI: 10.1002/mds.23052] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Chorea-acanthocytosis is a rare autosomal recessive neurodegenerative disorder with a complex clinical presentation comprising of a mixed movement disorder (mostly chorea and dystonia), seizures, neuropathy and myopathy, autonomic features as well as dementia and psychiatric features. Because the differential diagnosis is wide, clinical clues and red flags are important. We report here our observation of characteristic neck and trunk flexion and extension spasms in four cases with advanced chorea-acanthocytosis.
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Affiliation(s)
- Susanne A Schneider
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL, Institute of Neurology, Queen Square, London, United Kingdom
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14
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MaClean WE, Tervo RC, Hoch J, Tervo M, Symons FJ. Self-injury among a community cohort of young children at risk for intellectual and developmental disabilities. J Pediatr 2010; 157:979-83. [PMID: 20630541 DOI: 10.1016/j.jpeds.2010.05.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 03/16/2010] [Accepted: 05/28/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify risk factors for self-injurious behavior in young children with developmental delay and to determine whether that group is also more likely to exhibit other challenging behaviors. STUDY DESIGN A retrospective chart review of 196 children < 6 years of age referred for comprehensive neurodevelopmental evaluations. We analyzed child developmental level, receptive and expressive communication level, mobility, visual and auditory impairment, and co-morbid diagnoses of cerebral palsy, seizure disorders, and autism. RESULTS Sixty-three children (32%; mean age = 42.7 mo, 63% male) were reported to engage in self-injurious behavior at the time of the evaluation. Children with and without self-injurious behavior did not differ on overall developmental level, expressive or receptive language level, mobility status or sensory functioning, or in rates of identification with cerebral palsy, seizure disorders, or autism. However, the self-injurious behavior group was rated significantly higher by parents on destructive behavior, hurting others, and unusual habits. CONCLUSIONS Although self-injurious behavior was reported to occur in 32% of the cohort, the modal frequency was monthly/weekly and the severity was low. No significant differences were found for risk markers reported for adults, adolescents, and older children with intellectual and developmental disabilities. However, self-injurious behavior was comorbid with other behavior problems in this sample.
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A rhesus monkey model of self-injury: effects of relocation stress on behavior and neuroendocrine function. Biol Psychiatry 2008; 63:990-6. [PMID: 18164279 PMCID: PMC2486411 DOI: 10.1016/j.biopsych.2007.10.025] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 10/26/2007] [Accepted: 10/28/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Self-injurious behavior (SIB), a disorder that afflicts many individuals within both clinical and nonclinical populations, has been linked to states of heightened stress and arousal. However, there are no published longitudinal data on the relationship between increases in stress and changes in the incidence of SIB. This study investigated the short- and long-term behavioral and neuroendocrine responses of SIB and control monkeys to the stress of relocation. METHODS Twenty adult male rhesus macaques were exposed to the stress of relocation to a new housing arrangement in a newly constructed facility. Daytime behavior, sleep, and multiple measures of hypothalamic-pituitary-adrenocortical (HPA) axis function were investigated before and after the move. RESULTS Relocation induced a complex pattern of short- and long-term effects in the animals. The SIB animals showed a long-lasting increase in self-biting behavior, as well as evidence of sleep disturbance. Both groups exhibited elevated cortisol levels in saliva, serum, and hair, and also an unexpected delayed increase in circulating concentrations of corticosteroid binding globulin (CBG). CONCLUSIONS Our results indicate that relocation is a significant stressor for rhesus macaques and that this stressor triggers an increase in self-biting behavior as well as sleep disturbance in monkeys previously identified as suffering from SIB. These findings suggest that life stresses may similarly exacerbate SIB in humans with this disorder. The HPA axis results underscore the potential role of CBG in regulating long-term neuroendocrine responses to major stressors.
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Russell PSS. Self-injurious behavior to the lower extremities among children with atypical development: a diagnostic and treatment algorithm. INT J LOW EXTR WOUND 2006; 5:10-7. [PMID: 16543207 DOI: 10.1177/1534734605285165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-injurious behavior is a devastating and persistent condition that results in severe tissue damage, permanent impairment, or, occasionally, death. This aberrant behavior seen in specific childhood syndromes is compounded when the lower limbs are injured. Secondary complications are more frequent, depending on the site of the injury, resulting in significant morbidity and depletion of hospital resources. A substantial body of empirical evidence indicates that this deviant behavior is partly learned and partly of biologic origin. Therefore, this article presents a case study and reviews the components of a biopsychosocial paradigm of treatment for self-inflicted wounds to the lower extremity and formulates a prototypical algorithm for its diagnosis and management.
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Symons FJ, Sperry LA, Dropik PL, Bodfish JW. The early development of stereotypy and self-injury: a review of research methods. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:144-158. [PMID: 15634323 DOI: 10.1111/j.1365-2788.2004.00632.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The origin and developmental course of stereotypic and self-injurious behaviour among individuals with developmental disabilities such as intellectual disability (ID) or pervasive development disorders such as autism is not well understood. METHOD Twelve studies designed to document the prevalence, nature, or development of stereotypic and/or self-injurious behaviour in children under 5 years of age and identified as at risk for developmental delay or disability were reviewed. Comparisons were made with similar studies with typically developing children. RESULTS It appears that the onset of naturally occurring rhythmic motor stereotypies is delayed in young at-risk children, but that the sequencing may be similar. A very small database, differences in samples, measures, and designs limited the degree to which comparisons could be made across studies. CONCLUSION Future work is needed based on appropriately designed prospective comparison studies and uniform quantitative measures to provide an empirical basis for new knowledge about the early development of one of the most serious behaviour disorders afflicting children with ID and related problems of development.
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Affiliation(s)
- F J Symons
- Department of Educational Psychology, College of Education and Human Development, 238 Burton Hall 178 Pillsbury Drive, University of Minnesota, Minneapolis, MN 55455, USA.
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18
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Murray L. Self-Harm Among Adolescents with Developmental Disabilities: What Are They Trying to Tell Us? J Psychosoc Nurs Ment Health Serv 2003; 41:36-45. [PMID: 14621445 DOI: 10.3928/0279-3695-20031101-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Self-harm behavior exhibited by adolescents with developmental disabilities can be the most challenging behavior for caregivers and health care professionals to address. Past interventions have taken a behavioral approach and focused on functional analysis to guide assessment and treatment. However, self-harm behavior is becoming more recognized as a means of communication. Therefore, it is important for health care professionals and caregivers to listen to adolescents' attempts to communicate and try to understand the meaning of the behavior. Early assessment is crucial to understanding the meaning of the behavior, and early intervention is necessary to prevent escalation or chronicity. Thorough assessment guides interventions and must be implemented in the context of clients' families and social world, and the broader community. Establishment of trusting relationships among adolescents, their families, and health care professionals is imperative. This article discusses self-harm behavior from a psychosocial perspective related to prevalence, onset, purpose, maintenance, and escalation. It also introduces a comprehensive framework to guide assessment and intervention.
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Affiliation(s)
- Lee Murray
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada.
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Symons FJ, Clark RD, Hatton DD, Skinner M, Bailey DB. Self-injurious behavior in young boys with fragile X syndrome. Am J Med Genet A 2003; 118A:115-21. [PMID: 12655491 DOI: 10.1002/ajmg.a.10078] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this study, we distributed surveys to 67 families of young boys with fragile X syndrome to determine the prevalence, onset, form, function, location, and correlates of self-injurious behavior. Fifty-five surveys were completed (82%). The mean age of the boys at the time of the survey was 80 months (range = 20-144). Self-injurious behavior (SIB) was reported for 58% of the participants with a mean age of onset of 31 months. The mean number of forms of self-injury was 2 per participant. Biting was the most commonly reported form of self-injury with the fingers and back of the hand disproportionately targeted as the most prevalent self-injury body site. There was no linear increase in risk of SIB with age past 25 months. SIB was reported as most likely to occur following the presentation of difficult task demands or changes in routine. Significant group differences were found between overall ratings of problem behavior for boys with self-injury compared to those without self-injury. Groups did not differ on measures of fragile X mental retardation protein (FMRP), autism status, adaptive behavior, or age first medicated. Results are discussed in terms of future research designed to further elucidate the behavioral phenotype of fragile X syndrome.
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Affiliation(s)
- Frank J Symons
- Department of Educational Psychology, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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20
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Collins MSR, Cornish K. A survey of the prevalence of stereotypy, self-injury and aggression in children and young adults with Cri du Chat syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2002; 46:133-140. [PMID: 11869383 DOI: 10.1046/j.1365-2788.2002.00361.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the present study was to determine the prevalence and frequency of stereotypy, self-injurious behaviour (SIB), and aggression in children and adults with Cri du Chat syndrome (CCS), and to investigate the relationship between SIB, aggressive behaviour and stereotypy in these individuals. Sixty-six families of children and adults diagnosed with CCS completed the Behaviour Problems Inventory. Additional information relating to gender, chronological age, type of school/post-school occupation and medication was also included in the survey. Stereotyped behaviour was reported for 82% of subjects, more than half the sample displaying it on a daily basis. The occurrence percentage of 15 topographies of SIB suggested that head banging, hitting the head against body parts, self-biting and rumination are the most frequently occurring behaviours in CCS. Aggressive behaviour was reported for 88%, with a statistically significant negative correlation between age and the number of aggressive behaviours reported. The present findings suggest that specific types of stereotypy and SIB are observed frequently in CCS.
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Affiliation(s)
- M S Ross Collins
- North and West Belfast Health and Social Services Trust, Department of Clinical Psychology, Muckamore Abbey Hospital, Antrim, Northern Ireland
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Torres MC, Buceta MJ, Cajide MC. Development of a child with Joubert syndrome. THE SPANISH JOURNAL OF PSYCHOLOGY 2001; 4:72-8. [PMID: 11705345 DOI: 10.1017/s1138741600005679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The article describes the development of a child with Joubert Syndrome who, since the age of 16 months, has received personalized stimulation therapy at home and in the Early Intervention Unit (EIU) of the Faculty, in each of the five areas considered by the Portage Guide to Early Education: socialization, language, self-help, cognition, and motoricity. Repeated evaluations during the treatment (up to age 40 months) showed show progress in all developmental areas, as well as in general attitude to and capacity for learning. During treatment, greatest progress was made in the areas of cognition and communication.
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Affiliation(s)
- M C Torres
- Universidad de Santiago, Departamento de Psicología Evolutiva y de la Educación, 15706 Santiago de Compostela, Spain.
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Verri A, Uggetti C, Vallero E, Ceroni M, Federico A. Oral self-mutilation in a patient with rhombencephalosynapsys. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2000; 44 ( Pt 1):86-90. [PMID: 10711654 DOI: 10.1046/j.1365-2788.2000.00242.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Rhombencephalosynapsis (RS) is a rare cerebellar malformation. Its essential features are the absence of the incisura cerebelli posterior, fusion of the cerebellar hemispheres, the absence of the velum medullare anterius and nuclei fastigii, and fusion of the dentate nuclei, which are shifted towards the mid-line. Clinically, affected patients present with signs of cerebellar and motor disturbances. The present report describes a new patient affected by RS. The subject first presented at the age of 22 years because of a psychiatric symptomatology which was characterized by obsessive oral self-mutilation associated with an intellectual disability. Objective evaluation documented dysmorphic features, while neurological examination showed only a slight truncal ataxia. The subject's IQ was 74 on the Wechsler Scale (verbal IQ = 79, performance IQ = 74). Psychiatric evaluation with DSM-IV criteria documented an obsessive-compulsive personality disorder associated with emotional instability and oral self-mutilation. The typical picture of rhombencephalosynapsis was evident on magnetic resonance imaging. Both chromosomal analysis and routine biochemical investigations were normal. The relationship between oral self-injurious behaviour and cerebellar malformations is discussed with particular regard to the behavioural aspects of cerebellar congenital pathology in affective disorders and in autism.
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Affiliation(s)
- A Verri
- Neurological Institute C. Mondino Foundation, University of Pavia, Italy.
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Abstract
Self-injurious behaviour continues to be a drain on the resources for rehabilitation of the children with developmental disabilities. Pathogenesis and therapy seems fragmentary, with virtually every major neurotransmitter system being identified as the putative substrate for self-injurious behaviour. This phenomenon as it cuts across the diagnostic boundaries, although it is suggestive of a heterogeneous neurochemical basis, should call for the exploration of the biological event preceding the neurochemical cascade resulting in the behaviour. The authors argue that kindling is the preceding neurophysiological event resulting in self-injurious behaviour and, thus, can be effectively prevented pharmacologically.
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Affiliation(s)
- P S Russell
- Department of Psychiatry, Christian Medical College, Vellore, India.
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Collacott RA, Cooper SA, Branford D, McGrother C. Epidemiology of self-injurious behaviour in adults with learning disabilities. Br J Psychiatry 1998; 173:428-32. [PMID: 9926061 DOI: 10.1192/bjp.173.5.428] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There have been few epidemiological studies of the disabling and poorly understood disorder self-injurious behaviour among adults with learning disabilities. METHOD Interviews were undertaken with the carers of adults known to the Leicestershire Learning Disabilities Register (n = 2277). The Disability Assessment Schedule was used and information was also collected on demographic characteristics, developmental and physical status. RESULTS Self-injurious behaviour was present in 17.4% of the population. In 1.7% self-injurious behaviour occurred frequently and was severe. There was no gender difference between those with and without self-injurious behaviour. Both the chronological age and developmental quotient of individuals with self-injurious behaviour were lower than those of individuals without self-injurious behaviour. Autistic symptoms were more common among those with self-injurious behaviour. The association of self-injurious behaviour with a wide range of other maladaptive behaviours was highly significant. Logistic regression analysis retained age, developmental quotient, hearing status, immobility and number of autistic symptoms as explanatory variables for self-injurious behaviour. CONCLUSIONS Self-injurious behaviour is a prevalent and disabling disorder among adults with learning disabilities.
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Abstract
BACKGROUND Many sedative and antipsychotic agents have been used in the management of severe self-injury associated with learning disabilities. Their efficacy has been questioned. Recent research has identified some biological abnormalities associated with severe self-injury and allowed a more rational selection of treatment. METHOD Review of published literature, including trials, previous reviews and case reports. REPORTS There is evidence for the efficacy of opiate antagonists in the management of severe self-injury, and recent research has identified potential methods of predicting treatment response. Dopamine D1 antagonists and some agents affecting serotonin turnover may also be of benefit. CONCLUSIONS More rational psychopharmacological treatments for severe self-injurious behaviour may become available. Such treatments are difficult to evaluate for methodological and ethical reasons. They usually involve the clinical use of compounds for unlicensed indications, rather than trials of agents developed specifically to treat severe self-injurious behaviour. Combining psychopharmacological and psychological interventions may provide additional benefits.
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Affiliation(s)
- D J Clarke
- Department of Psychiatry, Queen Elizabeth Psychiatric Hospital, Birmingham
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