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Results for “Self-Injurious Behavior”

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PubMed1984

Effects of gross motor activities on the severe self-injurious tantrums of multihandicapped individuals.

The present study assessed the effects of gross motor activities on the self-injurious tantrums of three multihandicapped subjects. The tantrums did not seem related to specific environmental events and were rather infrequent, yet very severe. The study was carried out according to a withdrawal (ABAB) design. During baseline, the subjects executed routine activities that required minimal physical effort. During treatment, they performed gross motor activities that required considerable physical effort. These activities were designed to provide a wide variety of sensory (e.g., tactile, proprioceptive) input, but without tiring the subjects excessively. They were implemented when the subjects were in a quiet state. The results showed that concomitant with treatment, all subjects had a definite decline in the rate of self-injurious tantrums. Two subjects also exhibited a reduction in the duration of the tantrums.

Adolescent↗
PubMed1988

A functional analysis of multiple aberrant responses: a refinement and extension of Iwata et al.'s (1982) methodology.

This study extends an operant methodology for the analysis of variables which control aberrant responses displayed by mentally handicapped people. The proportion of time spent in individual, stereotyped topographies by three profoundly mentally handicapped subjects was observed by momentary time-sampling whilst they were repeatedly exposed to four analogue environments: Alone, Social Disapproval, Academic Demand and Unstructured Play. Two of the three subjects showed replicable effects of the analogue environments. One subject showed evidence of an interaction between stereotyped topography and type of analogue environment. This study shows that the operant methodology of Iwata et al. (1982), originally developed with self-injurious responses, can be successfully refined and extended to the analysis of a wider range of aberrant topographies.

Adult↗
PubMed1986

Pre-pubertal anorexia nervosa: a retrospective controlled study.

Pre-pubertal anorexia nervosa is a challenge to the explanatory powers of the many aetiological theories. This retrospective controlled study specifically compares 20 subjects with pre-pubertal anorexia nervosa to matched post-pubertal anorectic and pre-pubertal neurotic groups. The results show greater pre-morbid feeding problems in the index group and their families; both pre-pubertal groups show more behavioural problems before becoming ill. The illness is very similar in the two anorectic groups; they show comparable levels of sexual anxiety, and self-injury rates (35%) are equal. The implications of these findings for the various theories are discussed.

Age Factors↗
PubMed1988

Evaluation and management of self-mutilation.

Instances of deliberate self-injury are observed in both psychotic and nonpsychotic individuals. Patients with command hallucinations, religious preoccupations, substance abuse, and social isolation are the most vulnerable. Persons who request unnecessary surgical procedures for bizarre reasons also are at high risk. Such behavior constitutes a medical, surgical, and psychiatric emergency. A thorough psychiatric evaluation is mandated in every case. Vigorous psychiatric treatment and follow-up care involving the full range of pharmacologic, somatic, and psychologic interventions are indicated.

Adult↗
PubMed1990

A review of the Rett syndrome with a theory of autism.

In a review of results of clinical observations, girls from 2:03 (yrs:mos) at stages III and IV of the Rett syndrome (RS) and autistic children from 4:01 with or without severe mental retardation were compared as to their behavioral traits. Signs of concordance between the extremely low mental, affective and motor developmental levels, such as in the expression of the eyes, are a prominent feature of RS, whereas signs of higher cortical functions that are in contrast with insufficient relations to objects, people and space are a prominent characteristic in autism. It is argued that insistence on sameness, avoidance of social stimuli and self-injurious stereotypies of autistic children are neurotic reactions based on their insufficient object relations. On the basis of the clinical findings a theory is proposed, according to which there exists a system for involuntary contributions to the affective engagement in perception, which is insufficiently developed in autism and in earlier stages of RS. Regarding its structure and function, it is analogous to the phylogenetically old extrapyramidal system and its necessary involuntary emotional contributions to all voluntary movements and postures.

Adolescent↗
PubMed2025

Systematic Review of Symptoms of Catatonia in Autism Spectrum Disorder.

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.

Humans↗
PubMed1991

Comparative effects of gentle teaching and visual screening on self-injurious behaviour.

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.

Adult↗
PubMed1990

The treatment of Gilles de la Tourette syndrome by limbic leucotomy.

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.

Adult↗
PubMed1986

Psychiatric and behaviour disturbance in mental handicap.

This study reports on the relationship between behavioural and psychiatric perceptions of mentally handicapped subjects. A Standardised Psychiatric Interview schedule was found to characterise psychiatric problems in the mentally handicapped along eight dimensions: depression, neurasthenia, psychoticism, phobias, histrionic elation, hypochondria, mental retardation and medication effects. A Behavioural Disturbance Scale characterised disturbances along six dimensions: aggressive conduct, mood disturbance, withdrawal, antisocial conduct, idiosyncratic mannerisms and self-injury. The relationships between the two modes of assessment were investigated using multiple regression. Clinical features were not expressed in behaviour disturbances, nor were they related to age, sex or hospitalisation. The communicativeness of an interviewee was, however, found to limit the detection of depression.

Adolescent↗
PubMed1984

Behaviour disturbance and mental handicap: typology and longitudinal trends.

Behaviour disturbance was investigated in mentally handicapped adults who were living in hospital or at home. The first part of the study describes an empirically derived typology of disturbed behaviour patterns and gives the details of a scale by means of which behaviour disturbance can be quantified along six dimensions: aggression, mood disturbance, communicativeness, antisocial conduct, idiosyncratic mannerisms, and self-injury. The second part of the study used the scale in a longitudinal study of behavioural disturbance. Different forms of disturbed behaviour exhibited different kinds of longitudinal stability, and the long-term changes in one aspect of disturbance depended on subjects' other disturbance scores.

Adolescent↗
PubMed1986

Effects of response satiation procedures in the treatment of aerophagia.

A contingent response that previously increased self-injurious air-swallowing (aerophagia) by a profoundly mentally retarded woman (Holburn & Dougher, 1985) was shown to decrease her air-swallowing when the response was presented in accord with the response deprivation/satiation hypothesis, which suggests that any free-operant response can serve as a reinforcer or a punisher depending upon specific contigency arrangements. The results offer an explanation for the earlier increase in air-swallowing.

Adult↗
PubMed1985

A review of treatment research for self-injurious and stereotyped responding.

A review of current research in the treatment of self-injurious and stereotyped behaviour is made using rule-out criteria for methodologically inadequate studies and meta-analytic procedures. It was found that profoundly mentally retarded persons between 16 years of age and over are the most likely to be effectively treated. Sex of the subject seemed to have no effect, while the level of mental retardation and the degree to which it was a factor in treatment effectiveness was unclear. The behaviour most frequently treated were head hitting and body rocking. It may also be the case that reinforcement is more effective than frequently believed when compared to punishment. The greatest effectiveness was apparent with DRO, lemon juice therapy, time-out, air splints, and DRO plus overcorrection. The implications of these data for clinicians and future research are discussed.

Adolescent↗
PubMed1991

Psychoactive drug use in an institution for intellectually handicapped persons.

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.

Adolescent↗
PubMed1981

The effects of physical restraint on self-injurious behaviour.

Two experiments investigated the effects of two durations (one and three minutes) of physical restraint on the rate of self-injurious behaviour of a profoundly retarded girl. In the first experiment, a reversal design was used in which three-minute and one-minute restraint conditions were used sequentially. In the second experiment, an alternating treatments design was used in which the two conditions were alternated within the same experimental phase. Physical restraint was made contingent on each instance of SIB during experimental sessions. In the first experiment, with the introduction of three-minute restraint phase SIB increased to a rate high than baseline. However, it was reduced to near-zero levels during the one-minute restraint phase when it followed the three-minute phase. Although three-minute restraint did reduce the rate of SIB in the second experiments, it was found that one-minute restraint was more effective. In both experiments one-minute restraint was found to be more effective than three-minute restraint in reducing the rate of SIB.

Adolescent↗
PubMed1984

A clinical study of Gilles de la Tourette syndrome in the United Kingdom.

The clinical features of 53 British-born patients with Gilles de la Tourette syndrome are described. The mean age at onset of body tics was seven years and for vocalisations 11 years. Coprolalia was present in 39%, copropraxia in 21%, echolalia in 46% and echopraxia in 21%. Complicated antics and mannerisms were also common, often involving the compulsive touching of objects or self-injurious behaviour. Forty-six per cent of cases had a family history of tics in a single close relative and in two individuals a further member of the family had Gilles de la Tourette syndrome. Focal dystonia was present in four patients who had never received neuroleptics drugs and chorea was seen in two other untreated patients. In three patients acoustic startle consistently induced brief eye blink followed by a whole body jerk or jump. Rapid repetitive movements of the hands increased the frequency and severity of tics in 13 patients, but the performance of mental arithmetic under time pressure had a much more unpredictable effect. Electroencephalographic abnormalities occurred in eight (13%) but no definite CT brain scan abnormalities were detected. The incidence of left handedness did not differ from that in the general population and no evidence to suggest organic impairment was found on neuropsychological testing. This study provides no support for the notion that Gilles de la Tourette syndrome is a degenerative disorder of the central nervous system but provides some evidence for heterogeneity.

Adolescent↗
PubMedDate not supplied

Behaviour rehabilitation of the challenging client in less restrictive settings.

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.

Activities of Daily Living↗
PubMed1976

Differences between mentally retarded and normally intelligent autistic children.

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.

Achievement↗