Self-injurious Behaviour In People Research Articles

Self-Injurious Behavior in People with Intellectual Disabilities and Co-Occurring Psychopathology using the Self-Harm Scale: A Pilot Study

Self-injurious behavior (SIB) is one of the most detrimental behaviors for the person showing it, as well as for their environment. Nevertheless, structured clinical assessments of SIB are scarce. Staff completed a Self-Harm Scale (SHS) every time they witnessed SIB in clients with an intellectual disability (ID) and co-occurring psychopathology (N = 33). Descriptive statistics were conducted to explore the nature of the incidents of SIB and the characteristics of the people involved in the incidents. In 41 weeks, 104 SIB incidents were reported for 8 out of 33 clients (24%). Incidents were most prevalent on Mondays (23%). As far as the methods of SIB concerned, cutting was the most used method (63%). Clients who showed SIB differed significantly from clients who did not on gender, having a personality disorder and communicative abilities. This study was one of the few that used an incident-based record form to report SIB by direct observation. It is hoped that the SHS helps to gain more information about SIB, to improve individualized interventions. Further research is necessary to determine the psychometric properties and clinical utility of the scale.

Risk factors and topographies for self-injurious behaviour in a sample of adults with intellectual developmental disorders.

Self-injurious behaviour (SIB) is a prevalent form of challenging behaviour in people with intellectual developmental disorders (IDD). Existing research has yielded conflicting findings concerning the major risk factors involved, and in addition, SIB shows multiple topographies and presentations. Although presence of autism spectrum disorders (ASD) and severity of intellectual disability (ID) are known risk factors for SIB, there are no studies comparing SIB topographies by severity degrees of ID and ASD. The purpose of the present paper has been to identify risk factors and topographies for SIB in a representative, stratified and randomised sample of adults with IDD. This study was conducted on the basis of data collected by the POMONA-ESP project, in a sample of 833 adults with IDD. Data concerning demographic and health information, ASD symptoms, psychopathology and ID, have been analysed to determine the presence of risk factors for SIB among participants and to explore the occurrence and topographies of SIB across different severity levels of ID and ASD symptoms. Self-injurious behaviour prevalence in the sample was 16.2%. Younger age, oral pain, greater severity of ID, presence of dual diagnosis, psychiatric medication intake and higher scores on Childhood Autism Rating Scale were risk factors for SIB among participants, whereas number of areas with functioning limitations, place of residence, diagnosis of epilepsy and sex were not. SIB was more frequent in participants with ASD symptoms regardless of its severity level, and they displayed a higher number of different topographies of SIB. People with profound ID without co-morbid ASD symptoms showed similar results concerning SIB prevalence and topographies. Knowledge on risk factors and topographies of SIB might play a vital role in the development of prevention strategies and management of SIB in people with IDD. The mere presence of ASD symptoms, regardless of its severity level, can be a crucial factor to be taken into account in assessing SIB. Accordingly, the presence of SIB in people with ID, especially when presented with a varied number of topographies, might provide guidance on ASD differential diagnosis.

Self-injurious behaviour in people with intellectual disability and autism spectrum disorder.

This review summarises the recent trends in research in the field of self-injurious behaviour in people with intellectual disability and autism spectrum disorder. New data on incidence, persistence and severity add to studies of prevalence to indicate the large scale of the clinical need. A number of person characteristics have been repeatedly identified in prevalence and cohort studies that: can be considered as risk markers (e.g. stereotyped behaviour, autism spectrum disorder) and indicate possible causal mechanisms (e.g. sleep disorder, anxiety). Studies have started to integrate traditional operant learning paradigms with known person characteristics and reviews and meta-analyses of applied behaviour analytic procedures can now inform practice. Despite these positive developments interventions and appropriate support falls far short of the required need. Expansions in applied research are warranted to develop and evaluate innovative service delivery models that can translate knowledge of risk markers and operant learning paradigms into widespread, low cost routine clinical practice. Alongside this, further pure research is needed to elucidate the direction of causality of implicated risk factors, in order to understand and intervene more effectively in self-injury.

Self-injurious behaviour in people with intellectual disability

To provide a critical evaluation of a broad range of peer-reviewed published studies of relevance to self-injurious behaviour in people with intellectual disability and autism spectrum disorders. The review covers the prevalence of self-injurious behaviour, the characteristics of those showing the behaviour, self-injury in autism spectrum disorders, biological influences on self-injurious behaviour, behavioural assessment and psychological and pharmacological interventions. The recent literature describes systematic evaluation of the efficacy of aripiprazole, and parent training combined with risperidone. Meta-analyses of behavioural interventions provide evidence of their efficacy and related research describes beneficial modification to behavioural assessment procedures. The prevalence literature provides data on individual characteristics that are associated with persistence and presence of self-injury and that might be considered as risk markers. Pain behaviour appears to be associated with self-injury, with implications for theories of the involvement of endorphins, and as a causal factor. In combination, these research findings demonstrate the multiple influences on self-injurious behaviour that must be taken into account in the assessment, formulation, intervention process.

Self-injurious behaviour in people with eating disorders

Objective To determine the importance of self-injurious behaviour in people with eating disorders (ED) and to analyse the possible differences between ED subtypes. Method 109 patients with ED (51 anorexia nervosa (AN) and 58 bulimia nervosa (BN)), according to DSM-IV diagnostic criteria, who were consecutively referred to our unit, participated in this study. All cases were female. Assessment Subjects were assessed by means of a semi-structured clinical interview and self-report questionnaires (Eating Attitudes Test, EAT-40; Eating Disorders Inventory, EDI; Bulimic Investigatory Test Edinburgh, BITE; Body Shape Questionnaire, BSQ; Beck Depression Inventory, BDI; Social Anxiety Scale, SAD). Design Comparison of cases by considering the factors diagnosis and self-injurious behaviour. Results The presence of self-injurious behaviour (SIB) (32% of cases) was not associated with the diagnosis (p = 0.28). There was no association between SIB, suicide attempts, alcohol abuse and stealing, but a positive correlation between SIB and drug abuse was found (r = 0.284, p < 0.003). Likewise, patients with SIB showed higher scores on severity of the disorder (EDI, p < 0.04), depressive symptoms (BDI, p < 0.02), social anxiety (SAD, p < 0.02) and body image dissatisfaction (BSQ, p < 0.03). Conclusions: Eating disorders are pathologies in which self-injurious behaviour will be commonly present. SIB is associated with greater depression and anxiety and in general terms with greater severity of the disorder. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

Self-injurious behaviour in people with intellectual disability

Self-injurious behaviour in people with intellectual disability

A Study of the Topography and Nature of Self-Injurious Behaviour in People with Learning Disabilities

A survey of the prevalence and nature of self-injurious behaviour in people with learning disabilities was carried out in three networks of housing for people with learning disabilities, with particular reference to the body site targeted in the course of the self-injurious behaviour. This information was collected using the methodology of Symons and Thomson and, in line with their findings, self-injury sites were found to be non-randomly distributed on the body. The hypothesis that self-injury sites may overlap with acupuncture sites associated with analgesic effects was supported by the present data. The implications of such findings for the support and care of people with learning disabilities who self-injure are discussed.

Characterization of self-injurious behaviors in children and adults with Smith-Magenis syndrome.

A characteristic pattern of stereotypic and self-injurious behavior (SIB) distinguishes Smith-Magenis syndrome from many other genetic disorders. We examined the prevalence and severity of 11 specific types of SIB in 29 children and adults with Smith-Magenis syndrome. We confirmed the near universal presence of SIB in people with this disorder. The overall prevalence of SIB was found to increase with age as was the number of different types of SIB demonstrated by individuals with Smith-Magenis syndrome. The number of different types of SIB exhibited was also directly correlated with level of intellectual functioning. Our data suggest that with increasing age and ability levels, people with Smith-Magenis syndrome add to their repertoire of SIB from among a small number of specific behaviors.

Annotation: self-injurious behaviour in children with learning disabilities: recent advances in assessment and intervention.

There has been a discernible shift in the focus of research on self-injurious behaviour in people with learning disabilities in the last 10 years. Within the behavioural literature an emphasis on the technological features of treatments has been replaced by a more analytical approach. This has in part been spurred by the debate about the use of aversive stimuli in interventions but is also a product of research that has increased in breadth and volume. Gentral to this analytical approach is the examination of the environment determinants of self-injurious behaviour, best exemplified by the increasing attention paid to the methodology and utility of functional analysis. Research in this area has fostered a more prescriptive and constructional approach to behavioural interventions, by highlighting the adaptive properties of self-injury and by empirical study of a variety of environmental determinants. This shift in emphasis has promoted the importance of considering the functions of all challenging behaviours over their forms. Whilst aggression and self-injury may differ immensely in terms of the actions, they may be evoked and reinforced by similar events. They may thus be said to have functional equivalence, i.e. may serve the same purpose, and both will be influenced in the same way if the events are similarly manipulated. Viewed from this perspective self-injury is no different to other challenging behaviours. It shares with them the property of being able to influence the behaviour of others because of its aversive nature. Another development in self-injury research in the past 15 years has been the steady accumulation of studies that implicate biological determinants, more

Working with People with Learning Difficulties Who Self-Injure: A Review of the Literature

Self-injurious behaviour in people with learning difficulties has been found to be a common and health-threatening problem. As a consequence, there is an expanding literature addressing a variety of methods of intervention that are either designed to facilitate or to enforce the reduction or extinction of such behaviour. It is not clear, however, the extent to which such interventions are successful in achieving their avowed goal. This paper critically reviews the treatment of self-injurious behaviour, including work which takes psychodynamic, psychopharmacological, developmental, self-stimulation or learned behaviour perspectives, in order to establish the current status of interventions in this area. It is concluded that no single treatment approach has been shown to be effective in facilitating a reduction in the self-injurious behaviour of all clients. Rather, individualized programmes of intervention need to be constructed, using careful causal and functional analyses of behaviour. Moreover, such programmes, which may be multi-modal in nature, need to aim for interventions that are minimally or non-aversive.

Self-Injurious Behaviour in People with Learning Disabilities: Determinants and Interventions

Despite nearly three decades of empirical research, self-injurious behaviour (SIB) in people with learning disabilities remains poorly understood and difficult to ameliorate. This paper reviews the relevant findings from prevalence studies and the proposed theories of aetiology and presents an integrated model of operant and organic factors as determinants of SIB. The evidence for the model is reviewed and the impact made by theories of aetiology on the nature of interventions is evaluated. It is suggested that intervention efficacy is currently assessed without regard to the determinants of SIB and that such an outcome-led approach has not enhanced understanding or aided clinical decision-making. Future directions for research are proposed which stress the need for further consideration of the potential determinants of SIB and their relationship to intervention efficacy.

Operant Procedures in the Treatment of Self-Injurious Behaviour in People with a Mental Handicap

Despite numerous publications concerned with self-injurious behaviour (SIB).surprisingly little has been written about the wider social and ethical issues that may be encountered in the treatment of this behaviour. This artic1e auempts to identify some of these issues as they relate to research into SIB, as well as in the analysis and treatment of this kind of behaviour. The use of restraint, protective devices, reinforcement and aversive procedures are discussed and guidelines are suggested.

Self-injurious behaviour in people with a mental handicap

Self-injurious behaviour in people with a mental handicap

Self-injurious behaviour in people with mental handicap: a total population study.

A survey of self-injurious behaviour in people receiving services for mental handicap was carried out in one health region. Six hundred and sixteen adults and children were found to have engaged in self-injurious behaviour sufficient to have caused tissue damage in the previous 4 months and 596 of these were screened. Half were resident in hospital while 28% were in non-hospital residential care and the remainder (21%) were living at home. Nearly one-fifth (19%) showed self-injurious behaviour, of one or more types, at a rate of at least once per hour and a further 13% wore protective or restraining devices for all or part of the day or night. Only 2% were enrolled on formal psychological treatment programmes but nearly half were receiving psychotropic drugs (excluding anticonvulsants).