Self-injurious Behavior In Individuals Research Articles

A Qualitative Analysis of Family Caregiver Experiences Accessing Treatment for Self-Injurious Behavior in Individuals with Intellectual and Developmental Disabilities

ABSTRACT Introduction There is evidence of a gap between individuals with intellectual and developmental disabilities (IDD) who need treatment for self-injurious behavior (SIB) and those who receive treatment. The purpose of this study (n = 15) was to begin to understand the treatment gap from the perspective of family caregivers. Methods In semi-structured virtual interviews, family caregivers discussed their experiences of working with providers to treat their family member’s self-injury. Through a systematic process of quasi-inductive thematic analysis, researchers transcribed and analyzed the interviews and developed a working model of treatment pathways. Results Caregivers described many barriers to treatment access. Themes include Caregiver Driven, Importance of the Provider-Caregiver Relationship, Beliefs and Perceptions about SIB, Practical Constraints, Knowledge Gaps, and Wait Until Crisis. Conclusion The findings highlight the power of providers to support families coping with SIB in IDD. Specific ways providers can better facilitate treatment access are suggested. Future research directions should include provider interviews and focus groups and, ultimately, the development of interventions that consider access pathways as a key feature of any effective treatment plan.

Psychosocial Prediction of Self-Injurious Behavior: A Comparison of Two Populations

A psychosocial approach to predicting self-injurious behavior (SIB) may allow for more accurate predictions and enhance intervention for individuals who engage in SIB. We examined psychosocial predictors of SIB within and between two populations: individuals with traits of borderline personality disorder (BPD; N = 60) and college students (N = 116). All participants met the inclusion criteria of engaging in SIB at least once in the past year. All participants completed measures of psychological distress, social functioning, and SIB. Methods of SIB did not vary across samples, but SIB rates did. Psychological distress and population type (BPD or student) predicted SIB, whereas social factors did not. Additionally, we found a significant interaction wherein psychological distress was more related to SIB in individuals with traits of BPD. Accordingly, we recommend that counselors consider population and psychological distress when assessing SIB risk in clients.

Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis.

Recent studies suggest that psychotic experiences (PE) in the general population are associated with an increased risk of self-injurious behaviour. Both the magnitude of this association and the level of adjustment for confounders vary among studies. A meta-analysis was performed to integrate the available evidence. The influence of possible confounders, including variably defined depression, was assessed. A systematic review and meta-analysis was conducted including general population studies reporting on the risk of self-injurious behaviour in individuals with PE. Studies were identified by a systematic search strategy in Pubmed, PsycINFO and Embase. Reported effect sizes were extracted and meta-analytically pooled. The risk of self-injurious behaviour was 3.20 times higher in individuals with PE compared with those without. Subanalyses showed that PE were associated with self-harm, suicidal ideation as well as suicidal attempts. All studies had scope for considerable residual confounding; effect sizes adjusted for depression were significantly smaller than effect sizes unadjusted for depression. In the longitudinal studies, adjustment for psychopathology resulted in a 74% reduction in excess risk. PE are associated with self-injurious behaviour, suggesting they have potential as passive markers of suicidality. However, the association is confounded and several methodological issues remain, particularly how to separate PE from the full range of connected psychopathology in determining any specific association with self-injurious behaviour. Given evidence that PE represent an indicator of severity of non-psychotic psychopathology, the association between PE and self-injurious behaviour probably reflects a greater likelihood of self-injurious behaviour in more severe states of mental distress.

Stereotyped behaviors predicting self-injurious behavior in individuals with intellectual disabilities.

We examined the relation between stereotyped behavior and self-injurious behavior (SIB) for 1871 individuals with intellectual disabilities who had a score of >0 on the Behavior Problem Inventory (BPI-01; Rojahn et al., 2001). We report three main findings: First, structural equation modeling techniques (SEM) revealed that the BPI-01stereotyped behavior subscale scores predicted BPI-01 SIB subscale scores. Second, when stereotyped behavior was modeled as a predictor of SIB, mixture-modeling techniques revealed two groups of individuals: one in which stereotyped behavior was a strong, statistically significant predictor of SIB (69% of the sample), and another one in which stereotyped behavior was not a predictor of SIB (31%). Finally, two specific stereotyped behavior topographies (i.e., body rocking and yelling) were identified that significantly predicted five different SIB topographies (i.e., self-biting, head hitting, body hitting, self-pinching, and hair pulling). Results are discussed in terms of future research needed to identify bio-behavioral variables correlated with cases of SIB that can, and cannot, be predicted by the presence of stereotyped behavior.

An investigation of self-injurious behaviors in adults with severe intellectual disabilities

Self-injurious behavior (SIB) is commonly observed among individuals with intellectual disability (ID) living in state-run supports and services centers. Specific examples of SIB include poking oneself in the eye; harming oneself by hitting, scratching, or pinching; and pica (i.e., swallowing objects causing bodily harm). Previous research has focused on SIB in individuals with ID more generally without focusing on specific levels of ID or taking into account other important personal variables. This study examined 45 adults with severe ID living in two large state-run facilities in the Southeastern United States who were separated into groups for comparison (ASD and non ASD; verbal and nonverbal). Data was collected on the presence of SIB using the Autism Spectrum Disorder-Problem Behavior Adult Version (ASD-PBA). A two-way analysis of variance (ANOVA) was conducted to determine if there were significant differences between groups on rates of SIB. Individuals with ID and ASD exhibited significantly higher rates of SIB than individuals with only ID, F (1,43)=50.84, p<0.05. Furthermore, verbal individuals had significantly higher rates of SIB than nonverbal individuals, F (1,43)=57.612, p<0.05. There was a significant interaction between the effects of ASD diagnosis and verbal ability on rates of SIB, F (1,43)=50.84, p<0.05. The implications of these findings in the context of other research on ID, ASD, SIB, and verbal abilities are discussed.

Clozapine for self-injurious behavior in individuals with borderline personality disorder

Prior reports suggest that clozapine can markedly reduce aggression and self-injurious behavior in patients with borderline personality disorder (BPD). We present a series of four patients with BPD and persistent self-injurious behavior treated with clozapine at a state psychiatric hospital. After treatment with clozapine these patients ceased self-injurious behaviors and aggression, and no longer required intensive levels of observation or restrictive procedures. All were successfully discharged from the hospital soon after initiation of clozapine. Clozapine appears to be efficacious in the management of chronic suicidality, self-injurious behaviors and aggression in patients with severe BPD.

Reliability and Validity of a German Version of the Questions About Behavioral Function (QABF) Scale for Self-Injurious Behavior in Individuals With Intellectual Disabilities

The psychometric properties of a German version of the Questions About Behavioral Function Scale (QABF) (Matson & Vollmer, 1995) were examined in a sample of 522 individuals with intellectual disabilities residing in large facilities participated. The factor structure was first examined by exploratory factor analysis, yielding a five-factor-solution that was identical to the one described by the authors of the QABF and was statistically and clinically meaningful. Furthermore the factor structure was validated by confirmatory factor analysis. Fit indices indicated satisfactory model fit. Internal consistency was found to be good with Cronbach's alphas ranging from .84 to .62. Interrater reliability was fair with intraclass correlations ranging from .66 to.58.

Treatment approaches for self-injurious behavior in individuals with autism: Behavioral and pharmacological methods.

The most recent report published by the Centers for Disease Control (CDC) note the prevalence of autism to be approximately 1 out of every 150 live births with a male to female ratio of 4 to 1 (CDC, 2007). Autism is a heterogeneous neurodevelopmental disorder characterized by a wide array of symptoms but with some commonalities (Volkmar & Klin, 2005). Symptoms are primarily noted in three domains; specifically impairments in social interaction and communication, and engagement in repetitive behaviors. Social interaction impairments may include the failure to develop appropriate peer relationships, lack of desire to share social enjoyments or interests, or lack of social reciprocity. Impairments in communication may include a delay in the development of spoken language, the ability to initiate or continue a conversation, stereotyped or repetitive use of language, or lack of spontaneous pretend play or social imitative play. Finally, those with autism may also engage in repetitive and stereotyped behavior such as abnormal preoccupation with one or more patterns of interest, the need for strict routines, preoccupation with parts of objects, repetitive motor mannerisms, and self-injurious behavior. Self-injurious behavior (SIB) is any harmful behavior that an individual inflicts upon himself/herself and is usually considered to be the most pressing issue facing individuals with developmental disorders or mental retardation, including autism (Barrera, Violo, & Graver, 2007; Dawson, Matson, & Cherry, 1998; Murphy, Hall, Oliver & Kissi-Debra, 1999; Newell, Sprague, Pain, Deutsch, & Meinhold, 1999). About 5 to 16 percent of individuals with mental retardation exhibit SIB (Richman & Lindauer, 2005) with the severity of the SIB correlated with the severity of the delay (Baghdadli, Pascal, Grisi & Aussilloux, 2003). The etiology of autism and SIB are still being researched and debated. To date, there have been many candidate genes identified (e.g., SERT, MAOA, FOXP2) as potential causes of autism (Wassink, Brzustowicz, Bartlett, & Szatmari, 2004). Given the multitude of genes and the diversity of phenotypic expression, there is suggestion that the underlying cause of autism may vary across children. Similarly there are multiple behavioral and biological correlates that influence the onset of SIB. This paper specifically addresses the treatment of SIB focusing on behavioral and pharmacological methods. Within each of these methods there is a wide array of options that will be assessed. By reviewing all of these options we hope to provide an awareness of the treatment options available and provide a prompt for further research on effective treatments for SIB in individuals with autism. Treatment of Self-injury in Autism It is difficult to find one comprehensive course of treatment for autism as it is generally considered to be a heterogeneous disorder. Attempting to find comprehensive treatment for SIB is equally challenging as there may be multiple variables maintaining SIB--environmental and/or physiological Since is it hypothesized that in some cases, SIB may be the result of many interacting effects of genetics, biochemistry, and environment, understanding the behavioral and biological function of SIB may aid in the development of a treatment regimen, especially in those cases where SIB is treatment resistant, a common feature of SIB (Sandman, 1988). Behavioral Treatment of Self-injurious Behavior The foremost approach for the treatment of SIB in individuals with autism is behaviorally based. Research has demonstrated that for many individuals SIB is socially mediated warranting environmental modifications (Iwata, Pace, et al., 1994). Determining the function of SIB and selecting treatments based on these functions is paramount for successful treatment. Functional assessments allow for the identification of the relations between SIB and relevant antecedents and consequences on an individual basis (Iwata, Dorsey, Slifer, Bauman, & Richman 1982/1994; Iwata et al. …

Self-injurious behaviour in individuals with intellectual disabilities

In this paper we review literature published in 2004 on self-injurious behaviour in individuals with intellectual disabilities. Reviewed studies examine phenomenology and comorbidity, pharmacological and other interventions, genetic syndromes, and behavioural assessment and treatment. Key findings include the possible association between self-injury and impulse control and stereotyped behaviours. Reports on the use of pharmacological interventions provide little evidence for the use such interventions, although the findings of studies on naltrexone seem stronger. In the behavioural phenotype literature the predictors of self-injury in Prader-Willi syndrome are becoming more refined. The behaviour analysis literature reports further development of assessment methodology to cater for idiosyncratic functions and low-rate behaviours. Developments in the fields of applied behaviour analysis and genetic syndromes highlight the importance of tailored assessments and interventions. Evidence from the pharmacological literature suggests that although significant numbers of individuals are prescribed such interventions, the research evidence for their efficacy is, at best, weak.

A 4-year follow-up of treatment of self-injury

Data on the long-term effectiveness of behavioral treatment for self-injurious behavior in individuals with mental retardation is rare. We present 4-year follow-up data on a 28-year-old man whose severe self-injurious behavior was treated with brief contingent electric stimulation via the Self-Injurious Behavior Inhibiting System (SIBIS). Event data collected throughout follow-up showed reductions in head-hitting and head-banging from over 2,600 responses per hour to approximately 1 response per hour during much of the first 31 months of treatment. However, the rate of head-banging began increasing thereafter, with the SIBIS losing its effectiveness to such an extent that it was no longer clinically useful.