Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders.
While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal functional communication; (d) abnormal social functioning; (e) age; (f) the need for sameness; (g) rituals and compulsions. Half (52.3%, n = 126) of the children (n = 241, aged 2-19 years) demonstrated SIB. Abnormal sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Since atypical sensory processing and sameness have a greater relative impact on SIB, treatment approaches that focus on these factors may be beneficial in reducing self-harm in children with ASD.
The list of possible factors is helpful but, like everything in autism, the devil is in the details. It is one thing to say that "atypical sensory processing" is a major contributor to SIBs but it is quite another to find the specific sensory problem and to find a way to mitigate it.
We went through a rough couple of years where one of the twins would develop SIBs every fall that lasted until spring. There are few things more disheartening that having to physically restrain your child to prevent them from hurting themselves.
Fortunately, we managed to find a way to mitigate her SIBs after only three years of trying and she seems to be better able to regulate herself as she has gotten older. But those were very long years and my heart goes out to families that have to deal with SIBs on a daily basis.
References
Duerden EG, Oatley HK, Mak-Fan KM, McGrath PA, Taylor MJ, Szatmari P, Roberts SW. Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders. J Autism Dev Disord. 2012 Mar 16. [Epub ahead of print] PubMed PMID: 22422338. DOI: 10.1007/s10803-012-1497-9
I'm surpised that they left a factor out: Pain. If a child that cannot speak has a migraine headache, the SIB of pounding his head to communicate that pain is often mistaken for something else. There is a fascinating speech by Timothy Buie, at the end of the speech they show four counts of odd behavior in ASD individuals, some of it self injurous. In each case the individual had a painful gi issue they could not communicate. Timothy Buie has said that we have got to stop blaming all of the behavior on autism, in some situations there could be medical expalnations for it. The speech can be found at: http://www.wellsphere.com/autism-autism-spectrum-article/the-media-misrepresents-tim-buie-on-dietary-intervention-in-autism/937023
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"it is quite another to find the specific sensory problem and to find a way to mitigate it."
ReplyDeleteAbsolutely. Its nice when studies state the obvious, but finding a solution is what varies from person to person. Also what is the reason for rituals and compulsions, need for sameness etc? Someitmes the cause will help ascertain the solution.
Like you guys, it took us a few years to get rid of the one SIB we had. My son would hit his years unti the side of this face went bright red. He would hit the side of his head on objects (walls, people, bed etc) - although I remember it being around until last year, with significantly reduced frequency and intensity, now it seems like a distance memory thank God.
I am not sure what we did or he went through to stop.
I think SIBs are the singular most disheartening aspect of autism to parents. And the least studied. Interesting article. Sensory processing would be a good place to start.
ReplyDeleteSIB is complex. There are multiple antecedents that can change daily, weekly or monthly. You need a grab bag of tricks to help combat SIBs. And be able to act both pro-actively (i.e...meet the person's needs, don't leave them suffering in silence until they become so frustrated they engage in the SIB to tell you they are hurting or bored or need a drink or are hungry). You also need to be able to act ACUTELY, by immediately protecting the person by either placing a helmet on them or re-directing them. Sometimes acute intervention is simply getting them up, getting them engaged in another activity besides sitting in one position and hitting themselves. Most importantly is love patience and kindness. The autistic person who is self abusive can't help what they are doing. They need support. They need help.
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