Sunday, October 11, 2015

Predictors of Self-Injury in Children with Autism

Children with autism spectrum disorder (ASD) frequently engage in maladaptive behaviors such as aggression and rituals. The most distressing to caregivers and challenging for health care providers are self-injurious behaviors (SIB). These behaviors are classified as any type of action directed towards the self, resulting in physical injury. They are often rhythmic and repetitive and can range from mild head rubbing to severe head banging and may become life threatening. An improved understanding of the incidence and risk factors associated with SIB in autism is needed to develop treatment options.
A study in the Journal of Autism and Developmental Disorders assessed 7 factors that may influence self injury in a large group of 250 children and adolescents with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) impaired functional communication; (d) deficits in social interaction; (e) age; (f) the need for sameness; and (g) ) compulsive or ritualistic behavior. Other factors that may influence SIB incidence such as gender and ASD severity were also assessed. A series of diagnostic tests were administered either directly to the children and adolescents or to their parents to assess: (a) autism severity; (b) cognitive and adaptive ability; (c) and receptive and expressive language; (d) repetitive behaviors; and (e) self-injury.
The results indicated that half of the children and adolescents demonstrated SIB. Atypical sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Age, impaired functional communication, and ritualized behavior did not contribute significantly to self-injury. No significant effects of gender or severity of autistic symptoms were found in the study.
It appears that self-injury is highly prevalent in children and adolescents with ASD. Atypical sensory processing and the need for sameness were contributors to SIB in this study, indicating that clinicians may want to focus on these two risk factors to develop function-based treatment options for self-injury. It is critical that interventions that target the risk factors associated SIB be identified and implemented in clinical practice. Providing empirically supported behavioral interventions to children and adolescents with autism and SIB will not only impact directly on the problem behavior, but will enhance social, educational, and adaptive functioning as well. Further research is clearly needed to better understand additional contributing factors that may influence these complex behaviors in children with ASD. For example, temperament, ability to self-regulate emotions, and medication usage might contribute to increased self injury.
Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42:2460–2470. DOI 10.1007/s10803-012-1497-9
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)


Martha Gabler said...

Dr Wilkson, Thank you for providing this helpful information about the serious and heart-rending topic of Self-Injurious Behavior. There is so little support and guidance for families dealing with this, so this article is very much appreciated.

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