Treatment Of Self-injurious Behavior Research Articles

Comparison of behavioral intervention and sensory-integration therapy in the treatment of self-injurious behavior

The current study investigates the comparative effects of sensory-integration therapy and behavioral interventions on rates of self-injurious behavior (SIB) in a 9-year-old boy with diagnosis of autism. A functional analysis was conducted to identify the variables maintaining the self-injurious behavior. This analysis demonstrated that SIB was maintained by negative reinforcement as a result of escaping or avoiding demand situations. A sensory-integration therapy and a behavioral intervention were compared within an alternating treatments design. Results from this study clearly demonstrate that the behavioral intervention was more effective in reducing SIB than the sensory-integration therapy. Finally, in the best treatment phase, the behavioral intervention only was implemented and further reduction was observed in the frequency of SIB.

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 nursing home residents with dementia

To explore the phenomenology and prevalence of Self-Injurious Behaviour (SIB) in nursing home patients with dementia. Cross-sectional study of 110 nursing home patients with dementia. Nurses' ratings of SIB and other behavioural disturbances were compared to independent resident physician ratings of medical charts data pertaining to dementia type, dementia severity, prescribed psychotropic drugs, immobility and measures to restrain the patient. Instruments used were the Overt Aggression Scale (OAS, modified), Behaviour Rating Scale for Psychogeriatric Inpatients (GIP), Rating scale for Older Patients (BOP). SIB was observed in 22% of the dementia patients. Pinching or scratching oneself and banging one's fist against objects were most frequently reported. Five patients showed a combination of two types of SIB. As expected, SIB was modestly related to Aimless repetitive behaviour and Aggression and no association was found between SIB and Apathy. Correlates of SIB were prescribed psychotropics (i.e. benzodiazepines), immobility and measures to restrain the patient. Preliminary data suggest that SIB is a specific psychopathological phenomenon that is highly prevalent in nursing home patients with dementia. Future research should focus on the aetiology and treatment of SIB.

Ziprasidone as a Weight-Neutral Alternative in the Treatment of Self-Injurious Behavior in Adolescent Females

Self-injurious behavior (SIB) is a common and increasing problem (Klonsky, 2003, Muehlenkamp, 2004), especially in the subgroup of adolescent females (Hawton, 2003). Data about the pharmacological treatment of SIB in adolescent patients is limited (Hawton, 1998). As the causes which result in SIB often have their roots in a traumatic history, anxiety is an important issue to be considered in the treatment.

Functional analysis and treatment of self-injurious behavior in young children a summary of 30 cases.

The assessment and treatment of self-injurious behavior (SIB) has received much attention in the literature; however, few studies have focused on early intervention for this behavior. In the current study, functional analyses with developmentally appropriate modifications were conducted in an outpatient clinic with 30 children (aged 10 months to 4 years 11 months) to assess SIB and problem behavior in its early stages. The reported mean age of SIB onset was 17 months, and head banging was the most prevalent topography. Functional analyses identified sources of reinforcement for SIB in 62.1% of cases; with the inclusion of all forms of problem behavior, sources of reinforcement were identified for 87.5% of cases. Function-based treatments were developed for 24 cases, with functional communication training prescribed most often (70.8% of cases). Implications of these findings for the development of early intervention programs for SIB are discussed.

Behavioral treatment of self-injury, 1964 to 2000.

A quantitative analysis of behavioral research on the treatment of self-injurious behavior (SIB) over the past 35 years is provided. A literature search covering the period from 1964 to 2000 yielded 396 articles (706 participants) on the treatment of SIB. Most research participants have been male and diagnosed with severe/profound mental retardation. The use of reinforcement-based interventions has increased during the past decade, whereas the use of punishment-based interventions has decreased slightly; both of these trends coincide with the increase in the use of functional assessments. Most treatments have been highly effective in reducing SIB; nevertheless, the disorder persists in spite of an abundance of research, suggesting that a greater emphasis should be placed on prevention.

Extended analysis and treatment of self‐injurious behavior

AbstractIn experiment 1, an extended functional analysis of self‐injury was conducted with a 21‐year‐old male diagnosed with autism and profound mental retardation. The multielement phase yielded undifferentiated results. Subsequent blocking of conditions plus the addition of a component allowing access to multiple sensory stimuli suggested that self‐injury was unrelated to programmed positive or negative reinforcement contingencies. The behavior appeared to be automatically reinforced; its occurrence decreased when access to alternative sensory stimuli was provided. Experiment 2 evaluated a treatment condition in which response‐independent access to these sensory stimuli was provided within the participant's everyday environment. Baseline and treatment frequencies of self‐injury were compared in a combined, multiple‐baseline‐across‐settings and ABAB design. The level of self‐injury decreased substantially during treatment. These results support the use of extended analog analyses of aberrant behavior in instances in which undifferentiated responding occurs in the initial analogue analysis. Additionally, a procedure is described for generalizing the intervention derived from the experimental analysis into the participant's everyday environment. Copyright © 2001 John Wiley & Sons, Ltd.

Naltrexone Treatment of Dementia with Severe Self-Injurious Behaviors: A Single Case Study

The results of studies of the opiate antagonist Naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.

Treatment of self-injurious behavior and quality of life for persons with mental retardation.

Self-injurious behavior (SIB) is a highly problematic and damaging behavior with profound implications for a person's quality of life. Despite numerous reports documenting changes in self-injury, it is not well-known how these changes relate to systematic improvements in quality of life. We surveyed 41 journals from 1978 to 1996 to identify use of quality of life outcome measures following self-injury treatment. A sample of 138 research articles involving 436 subjects with self-injury was reviewed. Forty articles (29%) were found that contained some quality of life measure. Very little detailed information was available concerning the specific nature of change in life-style based on immediate changes in SIB. This lack of information and its possible implications are discussed.

Paradoxical Effects of Serotonin and Opioids in Pemoline-Induced Self-Injurious Behavior

Self-injurious behavior (SIB) is a symptom of various psychiatric disorders with differing etiologies. Although no generally effective pharmacological treatment of SIB is available, subsets of individuals exhibiting SIB have been found to respond to opioid antagonists and selective serotonin reuptake inhibitors (SSRIs). The present study evaluated the efficacy of these two treatments in the pemoline-induced model of self-biting behavior (SBB) in rats. Using a factorial design, adult rats receiving daily pemoline at 100 mg/kg or the peanut oil vehicle were pretreated with either distilled water vehicle (1 cc/kg), naltrexone (1 mg/kg), or paroxetine (1 mg/kg). Each day, animals were rated on the severity of SBB and also periodically behavioral changes were evaluated using various other outcome measures. Paroxetine significantly increased the severity of SBB induced by pemoline, while naltrexone only marginally increased the SBB. These results were not expected and suggest that further studies into the role of serotonin agonists and antagonists are needed in evaluating this model.

The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior.

Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988.

Biobehavioral Assessment and Treatment of Self-Injurious Behavior

Biobehavioral Assessment and Treatment of Self-Injurious Behavior

Effect of Tryptophan Treatment on Self-Biting and Central Nervous System Serotonin Metabolism in Rhesus Monkeys (Macaca mulatta)

Two studies were conducted to examine the effects of oral L-tryptophan (TRP) supplementation as a treatment for self-injurious behavior (SIB) and to investigate behavior and central serotonin turnover of male rhesus monkeys. In Study One, TRP was administered to seven individually housed rhesus monkeys with a recent history of spontaneous SIB. While the monkeys were on TRP treatment (100 mg/kg twice a day), cisternal cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid increased markedly (p=.0013) above baseline (baseline mean=207.6 pmol/ml ± 39; TRP mean=320.3 pmol/ml ± 83.4) , and the duration of self-biting behavior decreased below baseline (p=.03) . In Study Two, 14 individually housed rhesus monkeys without a history of SIB were placed on three different doses of TRP in random order (50, 100, and 200 mg/kg twice a day). TRP had no effect on any behavioral or biochemical variables in the normal monkeys. Conclusions: Supplemental tryptophan in well-tolerated doses reduced self-biting and increases serotonin turnover rate in male monkeys with a recent history of SIB. The same doses of TRP do not affect behavior or serotonin metabolism in male monkeys without a history of SIB.

Self-injurious behavior in mental retardation

Self-injurious behavior is commonly observed in the population with mental retardation, particularly persons with profound intellectual disability. This review covers the most recent research concerning the phenomenology, pathogenesis, and treatment of self-injurious behavior in mental retardation. Curr Opin Psychiatry 11:523-526.

Selective serotonin re-uptake inhibitors in the treatment of self-injurious behaviour in adults with mental retardation

Self-injurious behaviour (SIB) amongst people with learning disabilities is very common and is often difficult to treat. This study supports the theory that serotonin is involved in the development of SIB in these individuals. Twelve patients suffering from mild to severe mental retardation were treated with either fluoxetine or fluvoxamine. Ten of them showed marked improvement of their SIB, clinically as well as objectively (according to scores on the adaptive behaviour scale). The treatment had to be discontinued in the other two patients because of the development of severe adverse effects to the medication. The results of this study are therefore in line with previous studies showing the effectivity of Selective Serotonin Re-uptake Inhibitors in the treatment of SIB in mentally retarded individuals. © 1998 John Wiley & Sons, Ltd.

Self‐injurious Behaviour and People with Intellectual Disabilities: Assessing the Behavioural Knowledge and Causal Explanations of Care Staff

The Self‐Injury Behavioural Understanding Questionnaire (SIBUQ) is a 27‐item multiple response format questionnaire developed to examine the adoption of a behavioural perspective on self‐injurious behaviour (SIB). The questionnaire comprises three subscales (Knowledge, Action and Causal Explanation) to which there are six response types designed to elucidate types of causal explanations and likely responses to SIB given particular scenarios. Test‐retest reliability of the total score and response types within subscales is acceptable for most response types. The questionnaire was administered to four groups: contact (individuals in close contact with someone showing SIB), hospital staff (individuals in close contact with people with intellectual disabilities but not necessarily SIB), behavioural unit (individuals working on a unit for children with challenging behaviour which adopted a behavioural perspective) and behaviourally trained (individuals with formal qualifications in a behavioural approach to challenging behaviour). Comparisons between groups revealed significant differences on the total score, and all subscales. Post hoc analysis revealed that the contact group scored significantly lower than all other groups on all subscales. This group were also significantly more likely to choose a response which would reinforce SIB when considering what action to take and were more likely to impute an internal emotional type of causal explanation. An examination of the correlations between subscales revealed significant negative correlations between behavioural knowlege and the likelihood of choosing a reinforcing response and imputing internal emotional causal explanations. These findings suggest that the dissemination of a behavioural perspective to those in close contact with people who show SIB has not occurred. The implications of this conclusion are discussed with reference to the prevention and treatment of SIB.

Failure of Naltrexone Hydrochloride to Reduce Self-Injurious and Autistic Behavior in Mentally Retarded Adults

It is hypothesized that self-injurious behavior (SIB) and symptoms of autism may be due to overactivity in some opioid systems in the brain. We examined the efficacy and safety of naltrexone hydrochloride, an opioid antagonist, in the treatment of SIB and autism in mentally retarded adults. Thirty-three mentally retarded adults with autism and/or SIB participated in double-blind, placebo-controlled crossover studies. Active treatment was first a single 100-mg dose of naltrexone hydrochloride. Subsequently, 19 subjects were treated with 50 mg/d and 14 with 150 mg/d of naltrexone hydrochloride for 4 weeks. The outcome was assessed by means of direct observations (n = 11) and on the basis of scores on a list of target behaviors, the Aberrant Behavior Checklist, and the Clinical Global Impression Scale. Thirty-two subjects (seven with autism, 16 with autism and SIB, and nine with SIB) completed the trial. Naltrexone treatment failed to have therapeutic effects on SIB and autism. On the contrary, naltrexone increased the incidence of stereotypic behavior on the Aberrant Behavior Checklist, and the care staff evaluated the effect of the 50-mg/d treatment as being significantly worse than that of the placebo treatment as measured by the Clinical Global Impression Scale. Our findings suggest that naltrexone has no clinical value for a broad group of mentally retarded subjects with SIB and/or autism.

Clinical trials of D1 and D2 dopamine modulating drugs and self‐injury in mental retardation and developmental disability

AbstractWe review the rationale for conducting clinical trials of D1 and D2 dopamine modulators for self‐injurious behavior (SIB) among people with mental retardation and developmental disabilities. We include a brief history of the relevant behavioral research on SIB, the psychopharmacology of neuroleptic drugs for SIB, pharmacotherapy for SIB based on dopamine function, treatment for SIB with neuroleptics, SIB and dopamine supersensitivity, and the D1 dopamine hypothesis and SIB. We also present controlled case studies of the use of clozapine to treat chronic, refractory SIB in three individuals with profound mental retardation. One was a dramatic responder at 225 mg per day; one was a partial responder at 300 mg per day; and one showed a decrease in stereotypy, but not SIB, at 100 mg per day. Studies from rats, monkeys, and humans support the hypothesis that the D1 dopamine receptor system in the nigrostriatal pathway of the basal ganglia plays a key role in SIB in some cases. © 1995 Wiley‐Liss, Inc.

Behavioral and naltrexone treatment of self-injurious behavior

Severe self-injurious behavior in a boy with severe mental retardation and autistic disorder was successfully treated with a behavioral treatment package following a trial of naltrexone to reduce self-injurious behavior. The subject was a 7-year-old boy who was hospitalized for self-injurious behavior, aggression, and a reported increased irritability. During baseline assessment, the subject was physically and verbally interrupted and redirected whenever he engaged in self-injurious behavior. During the first treatment phase, pediatric “no-no” splints were applied and systematic splint fading began. In addition, differential reinforcement of other behaviors (DRO) and a brief hand restraint were implemented. In the second treatment phase, naltrexone was administered with the continued use of systematic point fading, DRO and brief hand restraint. The third treatment phase consisted of a placebo trial and the same behavioral treatment. In the final phase, restraint fading continued and reinforcement was faded to a variable interval (VI)-3 minute schedule, as well as the use of brief hand restraint. This treatment package was effective in reducing this boy’s severe self-injurious behavior to zero upon discharge from the hospital. Follow-up data from the school indicated continued success with the use of the brief contingent hand restraint as well as reinforcement delivered on a VI-3 min schedule.

Descriptive and experimental analyses of variables maintaining self-injurious behavior.

Independent descriptive (correlational) and functional (experimental) analyses were conducted to determine the extent to which the two methods would yield data supporting similar conclusions about variables maintaining the self-injurious behavior (SIB) of 6 subjects. For the descriptive analyses, subjects were observed in their residences and at training sites at various times each day while observers recorded naturally occurring sequences of specified subject and staff behaviors. The subjects also participated in a day program for the assessment and treatment of SIB, in which they were exposed to functional analyses that manipulated potential maintaining variables in multielement designs. Both sets of data were analyzed via conditional probabilities to identify relevant antecedent and consequent events for subjects' SIB. Using outcomes of the experimental analysis as the standard for comparison, results indicated that the descriptive analysis was useful in identifying the extent to which SIB was related to social versus nonsocial contingencies, but was limited in its ability to distinguish between positive and negative reinforcement (i.e., attention versus escape).