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Self-injury, a common problem among retarded children is thought to be a behavioural manifestation of an organic disease and the usual treatment has been through drugs or physical restraint. Psychological treatment techniques were used to control such behaviour in a de Lange syndrome patient. The treatment was effective in producing clinically significant control of self-injurious behaviour.
Rage is characterized by an unpredictable and primitive display of violence that is out of proportion to the provoking event and often threatens serious self-injury or harm to others. New insight into the pathogenesis of unpredictable violent behavior has been gained largely as a result of neurochemical, neuropsychological and brain imaging studies. This article examines episodic rage from a neuropsychiatric perspective. Three cases illustrating the evaluation and treatment of rage in childhood and adolescence are presented.
Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.
This study deals with the controlling of self-injurious behaviour in a profoundly retarded girl. The main therapeutic tool, social isolation, was carried out under normal ward conditions and was statistically evaluated in an intra-subject design without reversal conditions. The procedure reduced the self-injurious behaviour to a near-zero level.
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The cases of three self-injurious patients suffering with borderline personality disorder are briefly presented. From this clinical base, the consultant describes a cognitive-behavioral psychotherapeutic model and how it might be applied to the treatment of these and similar patients. A dialectical behavioral approach is used to describe three major dichotomies and their application. The consultant also illustrates how cognitive-behavioral therapy may be integrated with more dynamic-analytic approaches, and proposes a strategy and methodology that establish and reinforce the treatment alliance in developing a treatment plan.
Self-mutilation in non-human mammals is a well-established, although not a widely known phenomenon, which has been reported under zoo and laboratory conditions. In macaque monkeys, laboratory rearing and isolation are important predisposing factors, and the more serious self-injury is initiated by some immediate stimulating event. It is commonly accompanied by behaviour normally shown by the animal in a fighting context. Lower mammals are also known to mutilate themselves under laboratory conditions after administration of drugs wich probably cause increased sympathetic activity. The implications of this behaviour for an understanding of states of self-injury in man are discussed.
In abuse dwarfism the behavioral signs include some or all of the following: (1) a history of unusual eating and drinking behavior, reversible on change of domicile, such as eating from a garbage can and drinking from a toilet bowl, stealing food, alleged picky eating and rejecting food at the table, polydipsia and polyphagia, possibly alternating with vomiting and possibly also with self-starvation; (2) a history of such behavioral symptoms as enuresis, encopresis, social apathy or inertia, defiant aggressiveness, sudden tantrums, crying spasms, insomnia, eccentric sleeping and waking schedule, pain agnosia, and self-injury, all occurring only in the growth-retarding environment; (3) retarded motor development, with improvement on removal of the child from the domiclle of abuse; (4) retarded intellectual growht, reversible on change of domicile by as much as 30 to 50 IQ points; and (5) a history of pathologic family relationships, including unusual cruelty and neglect, either somatic or psychic or both.
Catatonia is a complex neuropsychiatric syndrome characterized by disturbances in mood, motor function, behavior and speech. It is increasingly recognized in individuals with autism spectrum disorder (ASD), although its identification remains challenging due to the overlapping clinical features of the two conditions. Shared characteristics, such as echophenomena, mannerisms, social indifference and repetitive behaviors can obscure accurate diagnosis. Although reports suggest a significant prevalence of catatonia among individuals with ASD, the condition remains poorly understood and frequently under recognized, leading to substantial diagnostic and treatment challenges. A systematic review was conducted to characterize the symptoms of catatonia in individuals with ASD. The literature search included peer-reviewed journal articles published in English from 1980 onward, focusing on studies examining co-occurring catatonia and ASD. A qualitative framework analysis was implemented to evaluate 45 peer-reviewed studies, with findings interpreted in relation to, and extending beyond, the diagnostic criteria for catatonia outlined in the International Classification of Diseases, 11th revision (ICD-11). The objective was to identify symptom patterns extending beyond current diagnostic frameworks and to support improved clinical recognition and diagnostic precision in ASD populations. The review identified six primary symptom clusters associated with catatonia in individuals with ASD: (1) psychomotor activity, (2) speech disturbances, (3) changes in behavior/skills/functions, (4) mental health symptoms, (5) physiological symptoms, and (6) symptoms related to arousal and awareness. Notably, several symptoms observed within these clusters are not currently included in the ICD-11 diagnostic criteria for catatonia. These additional symptoms include tics, motor compliance, incoherent speech, self-injury, impaired cognition, and appetite changes, suggesting a broader clinical presentation of catatonia in ASD populations than is presently captured in existing diagnostic frameworks. The findings of this review highlight the significance of enhancing clinicians' awareness and understanding of how catatonia manifests in individuals with ASD. Most notably, six symptom clusters, psychomotor changes, speech disturbances, behavioral and functional regression, affective and psychiatric symptoms, physiological symptoms, and arousal/awareness disturbances, were observed. Several symptoms identified in this review are not included in the current diagnostic criteria, and their recognition may facilitate in earlier identification and timely intervention, potentially preventing the severe consequences of untreated catatonia in this population.
Gentle teaching and visual screening procedures have been used to control severe behaviour problems in persons with mental retardation. An alternating treatments design was used to compare gentle teaching, visual screening and a task-training condition in the reduction of high levels of self-injury of an adult with profound mental retardation. Following baseline, a task-training condition using standard behavioural techniques was implemented to establish the effects of training the subject on age-appropriate tasks. Results showed a modest reduction in self-injury. This was followed by an alternating treatments phase in which visual screening, gentle teaching and no-treatment control conditions were compared. Both procedures were superior to the control condition in reducing self-injury, with visual screening being more effective than gentle teaching. When visual screening was implemented across two and then all three daily conditions, self-injury was further reduced to near-zero levels. Bonding occurred at the same low levels under both treatments, contrary to the predictions of gentle teaching's proponents.
The authors report the use of massage in a case of severe self-injurious behaviour in a girl with Cornelia de Lange syndrome, after failing to elicit a response to conventional management for 10 years. Improvement was dramatic and the possible mechanisms are discussed.
A patient with Gilles de la Tourette syndrome and severe self-injurious compulsions who had failed to respond to drug treatment and behavioural therapy obtained a complete and sustained resolution of his destructive behaviour and improvement in his tics following bilateral limbic leucotomy.
OBJECTIVE: To study the use of psychoactive drugs for the treatment of long-stay developmentally disabled individuals in an institution in New South Wales. SETTING: Three wards dedicated to the long-term care of developmentally disabled individuals situated on the premises of a large psychiatric hospital. SUBJECTS: All residents (n = 53) of these wards in August 1989. METHOD: All subjects were examined by the author. Charts and medication records were extensively reviewed. Mental retardation was classified by DSM-III-R criteria. Categorisation of problem behaviour was done with the assistance of nurses, who also supplied information on behavioural problems and functional level and completed checklists of self-injurious and stereotypic behaviour. A standardised neurological examination was performed and scales for abnormal involuntary movements completed. RESULTS: The most commonly used drugs were the neuroleptics, with 60.4% of subjects currently receiving one or more neuroleptic drug at relatively large doses. The use of these drugs was not associated with current or past psychiatric illness, but was more closely related with the severity of problem behaviour. Thirty-four per cent of the subjects receiving neuroleptics had dyskinetic movements suggestive of tardive dyskinesia, and 30% had mild tremor. Antidepressant, anxiolytic and sedative drugs were used less commonly. The management of epilepsy was considered to be suboptimal. CONCLUSION: Even though studies over the last two decades have consistently highlighted the problem of overmedication of intellectually handicapped individuals in institutions, the problem does not seem to have been redressed in at least some institutions.
Individuals who have sustained traumatic brain injury may provide friends, family, and rehabilitation professionals with challenges through an increased likelihood of their engaging in socially inappropriate behaviours. At extremes the inappropriate behaviours include vocal and physical assault, non-compliance, self-injurious behaviours, elopement, and property destruction. While these maladaptive behaviours are by themselves troublesome, for some individuals they provide severe barriers to rehabilitation. One option for the challenging rehabilitation client is a neurobehavioural programme, typically offering an access-limited or otherwise secure physical environment and which focuses on behaviour reduction. While outcomes from neurobehavioural programmes are typically positive, their expense and the negative connotations of this type of programme will at times dissuade family members from enrolling the client. We describe an alternative, less restrictive behavioural programme operated in the physical and social context of a larger, more typical community-based rehabilitation programme for traumatically brain-injured individuals. This programme has been in operation for nearly three years, successfully serving more than 200 clients, of which approximately 20% posed behaviour management problems. Identified variables accounting for these successes include: formal guidelines for programme development, staff training and monitoring, data collection, integration of an interdisciplinary team, discharge planning and post-discharge follow-up. We provide a general programme description followed by discussions of four brief case studies to illustrate basic principles of the programme. Programme strengths are discussed, as are constraints placed on the programme by the physical and social environments in which it operates.
Autistic children with an IQ below 70 and with an IQ above 70 were systematically compared. The two groups differed somewhat in the pattern of symptoms, but were closely similar in terms of the main phenomena specifically associated with autism. However, the low IQ and high IQ autistic children differed more substantially in terms of other symptoms such as self-injury and stereotypies and there were major differences in outcome. The possibility that the nature of the autistic disorder may differ according to the presence or absence of associated mental retardation needs to be taken into account in planning studies of etiology.
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Self-injurious behaviour (SIB) is a relatively common phenomenon among severely retarded persons and involves various repetitious behaviours resulting in tissue damage. Perhaps because of the damage it does, the behaviour has generated a considerable amount of applied research and discussion, and much of this research has involved attempts to reduce SIB through the manipulation of antecedents or consequences. The purpose of this paper was to determine the extent to which those conducting this research used a functional analysis of SIB to determine why the behaviour was occurring and subsequently matched treatment to one of these reasons. Results showed that only a small proportion of the studies reported analyses that would allow the experimenter to determine reasons for the self-injurious behaviour. The discussion centres on why functional analyses are not conducted in ways that would lend treatment to be based on hypotheses of why SIB occurs.