children with typical development can show a range of stereotyped and self-injurious behaviour (SIB) e.g. headbanging, head-hitting, self-biting
meaning of these behaviours in the course of development remains a matter of discussion
however, the disappearance of SIB often coincides with the mastery of communication tools, especially language
in a survey of SIB in people receiving intellectual disabilities services, it was estimated that 12% of adults in hospitals and 3% of those in the community displayed SIB, while from 3% to 12% of children with intellectual disabilities showed SIB, depending on age (1)
SIB has been reported to be associated with poor communication skills
association with a wide range of medical condition also suggests the role of neurotransmission disturbances (2)
there are several risk factors that increase the probability of developing SIB
following factors are associated with increased probability of developing SIB:
(1) severe or profound developmental disabilities;
(2) sensory or physical disability; and
(3) specific genetic disorders and syndromes
a meta-analysis of studies conducted over the past 30 years on SIB exhibited by individuals with IDD (3)
suggested that the three top-risk factors for SIB were
(1) severe or profound intellectual delay ;
(2) diagnosis of autism; and
(3) deficits in receptive or expressive communication
a study explored the factors related to the outcome of self-injurious behaviour (SIB) in children with pervasive developmental disorders (PDD) (1):
speech deficits and autism severity were significant risk factors for a negative outcome
behavioural theories also suggest that SIB is related to external (e.g. social pressures, sleep deprivation, changes in environment) and/or internal factors (e.g. emotion, puberty, maturation, ageing, nutritional changes, overall heath) through positive or negative reinforcement
general agreement among clinicians and scientists that well-established cases of SIB are more difficult to treat than emerging SIB with fewer historical response-reinforcer relations
functional communication training has proven to be a very effective treatment for well-established cases of SIB maintained by social consequences
key issue for FCT is the notion of response covariation, also referred to as response competition or functional equivalence
response covariation has been demonstrated when participants are taught to emit a low effort response that produces immediate access to the same reinforcer that maintains SIB
later intervention may be slower to produce desired long-term treatment effects, given greater response strength and more resistance to extinction (e.g. greater response-reinforcer relations for SIB)
Reference:
(1) Baghdadli A et al.What Factors are Related to a Negative Outcome of Self-Injurious Behaviour During Childhood in Pervasive Developmental Disorders? JARDI 2008; 21 (2): 142-149.
(2) Richman DM. Annotation: Early intervention and prevention of self-injurious behaviour exhibited by young children with developmental disabilities.JIDR 2008; 52 (1):3-17.
(3) McClintock K et al. Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. JIDR 2003;47: 405-16.
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