Journal of Autism and Developmental Disorders

, Volume 47, Issue 3, pp 701–713 | Cite as

Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control

Original Paper

Abstract

Self-injury is common in autism spectrum disorder (ASD); however few studies have investigated correlates of self-injury or the putative associations with self-restraint. Questionnaire data on self-injury, self-restraint, health conditions, overactivity/impulsivity and repetitive/restricted behavior were collected on 208 children and 216 adults with ASD (mean age = 24.10, range 6–61). Self-injury and self-restraint were frequent and significantly associated in both children (45.7% and 40.9%, p < 0.001) and adults (49.1, and 42.6%, p < 0.001). Severe self-injury was predicted by lower ability, health conditions and overactivity/impulsivity in children (p < 0.001) and repetitive/restricted behavior and overactivity/impulsivity in adults (p < 0.001). These data provide preliminary support for a developmental model of self-injury and self-restraint in which painful health conditions and compromised behavioral control influence the presence and trajectory of self-injury in ASD.

Keywords

Autism spectrum disorder Self-injury Self-restraint Prevalence Impulsivity Pain 

References

  1. Arron, K., Oliver, C., Moss, J., Berg, K., & Burbidge, C. (2011). The prevalence and phenomenology of self-injurious and aggressive behavior in genetic syndromes. Journal of Intellectual Disability Research, 55, 109–120.CrossRefPubMedGoogle Scholar
  2. Baghdadli, A., Pascal, C., Grisi, S., & Aussilloux, C. (2003). Risk factors for self-injurious behaviors among 222 young children with autistic disorders. Journal of Intellectual Disability Research, 47, 622–627.CrossRefPubMedGoogle Scholar
  3. Bodfish, J. W., Crawford, T. W., Powell, S. B., Parker, D. E., Golden, R. N., & Lewis, M. H. (1995). Compulsions in adults with mental retardation: Prevalence, phenomenology, and comorbidity with stereotypy and self-injury. American Journal on Mental Retardation, 100, 183–192.PubMedGoogle Scholar
  4. Burbidge, C., Oliver, C., Moss, J., Arron, K., Berg, K., Furniss, F., et al. (2010). The association between repetitive behaviours, impulsivity and hyperactivity in people with intellectual disability. Journal of Intellectual Disability Research, 54(12), 1078–1092.CrossRefPubMedGoogle Scholar
  5. Carr, E. G., & Blakeley-Smith, A. (2006). Classroom intervention for illness-related problem behavior in children with developmental disabilities. Behavior Modification, 30, 901–924.CrossRefPubMedGoogle Scholar
  6. Carr, E. G., & Owen-DeSchryver, J. S. (2007). Physical illness, pain and problem behavior in minimally verbal people with developmental disabilities. Journal of Autism and Developmental Disorders, 37, 413–424.CrossRefPubMedGoogle Scholar
  7. Carr, E. G., Smith, C. E., Giacin, T. A., Whelan, B. M., & Pancari, J. (2003). Menstrual discomfort as a biological setting event for severe problem behavior: Assessment and intervention. American Journal on Mental Retardation, 108, 117–133.CrossRefPubMedGoogle Scholar
  8. Christensen, T. J., Ringdahl, J. E., Bosch, J., Falcomata, T. S., Luke, J. R., & Andelman, M. S. (2009). Constipation associated with self-injurious and aggressive behavior exhibited by a child diagnosed with autism. Education and Treatment of Children, 32, 89–103.CrossRefGoogle Scholar
  9. Cooper, S. A., Smiley, E., Allan, L. M., Jackson, A., Finlayson, J., Mantry, D., et al. (2009). Adults with intellectual disabilities: Prevalence, incidence and remission of self-injurious behavior, and related factors. Journal of Intellectual Disability Research, 53(3), 200–216.CrossRefPubMedGoogle Scholar
  10. Courtemanche, A. B., Black, W. R., & Reese, R. M. (2016). The relationship between pain, self-injury, and other problem behaviors in young children with autism and other developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 121(3), 194–203.CrossRefPubMedGoogle Scholar
  11. Davies, L. E., & Oliver, C. (2016). Self-injury, aggression and destruction in children with severe intellectual disability: Incidence, persistence and novel, predictive behavioral risk markers. Research in Developmental Disabilities, 49, 291–301.CrossRefPubMedGoogle Scholar
  12. de Winter, C. F., Jansen, A. A. C., & Evenhuis, H. M. (2011). Physical conditions and challenging behavior in people with intellectual disability: a systematic review. Journal of Intellectual Disability Research, 55, 675–698.CrossRefPubMedGoogle Scholar
  13. 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(11), 2460–2470.CrossRefPubMedGoogle Scholar
  14. Esbensen, A. J., Seltzer, M. M., Lam, K. S. L., & Bodfish, J. W. (2009). Age related differences in restricted repetitive behaviors in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 57–66.CrossRefPubMedGoogle Scholar
  15. Forman, D., Hall, S., & Oliver, C. (2002). Descriptive analysis of self-injurious behavior and self-restraint. Journal of Applied Research in Intellectual Disabilities, 15, 1–7.Google Scholar
  16. Fovel, J. T., Lash, P. S., Barron, D. A., & Roberts, M. S. (1989). A survey of self-restraint, self-injury, and other maladaptive behaviors in an institutionalized retarded population. Research in Developmental Disabilities, 10, 377–382.CrossRefPubMedGoogle Scholar
  17. Guess, D., & Carr, E. G. (1991). Emergence and maintenance of stereotypy and self-injury. American Journal on Mental Retardation, 96, 299–319.PubMedGoogle Scholar
  18. Hyman, P., Oliver, C., & Hall, S. (2002). Self-injurious behavior, self-restraint and compulsive behaviors in Cornelia de Lange syndrome. American Journal on Mental Retardation, 107, 146–154.CrossRefPubMedGoogle Scholar
  19. Kerth, D. M., Progar, P. R., & Morales, S. (2009). The effects of non-contingent self-restraint on self-injury. Journal of Applied Research in Intellectual Disabilities, 22(2), 187–193.CrossRefGoogle Scholar
  20. King, B. (1993). Self-injury by people with mental retardation: A compulsive behavior hypothesis. American Journal on Mental Retardation, 98, 93–112.PubMedGoogle Scholar
  21. Kushlick, A., Blunden, R., & Cox, G. (1973). Method of rating behavior characteristics for use in large-scale surveys of mental handicap. Psychological Medicine, 3, 466–478.CrossRefPubMedGoogle Scholar
  22. Luzzani, S., Macchini, F., Valade, A., Milani, D., & Selicorni, A. (2003). Gastroesophageal reflux and Cornelia de Lange syndrome: Typical and atypical symptoms. American Journal of Medical Genetics Part A, 119, 283–287.CrossRefGoogle Scholar
  23. McClintock, K., Hall, S., & Oliver, C. (2003). Risk markers associated with challenging behaviors in people with intellectual disabilities: a meta-analytic study. Journal of Intellectual Disability Research, 47, 405–416.CrossRefPubMedGoogle Scholar
  24. Melzack, R. & Wall, P. D. (1965). Pain Mechanisms - A New Theory. Science, 150, 971-&amp.Google Scholar
  25. Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biological psychiatry, 57(11), 1424–1435.CrossRefPubMedGoogle Scholar
  26. O’Reilly, M. F. (1997). Functional analysis of episodic self-injury correlated with recurrent otitis media. Journal of Applied Behavior Analysis, 30, 165–168.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Oliver, C., Murphy, G., Hall, S., Arron, K., & Leggett, J. (2003). Phenomenology of self-restraint. American Journal on Mental Retardation, 108, 71–81.CrossRefPubMedGoogle Scholar
  28. Oliver, C., Petty, J., Ruddick, L., & Bacarese-Hamilton, M. (2012). The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability. Journal of Autism and Developmental Disorders, 42(6), 910–919.CrossRefPubMedGoogle Scholar
  29. Oliver, C., & Richards, C. (2015). Practitioner Review: Self-injurious behavior in children with developmental delay. Journal of Child Psychology and Psychiatry, 56(10), 1042–1054.CrossRefPubMedGoogle Scholar
  30. Petty, J. (2006). Self-injurious behaviour in children with severe intellectual disabilities. Unpublished Ph.D. thesis.Google Scholar
  31. Powell, S. B., Bodfish, J. W., Parker, D., Crawford, T. W., & Lewis, M. H. (1996). Self-restraint and self-injury: Occurrence and motivational significance. American Journal on Mental Retardation, 101, 41–48.PubMedGoogle Scholar
  32. Rice, L. J., Gray, K. M., Howlin, P., Taffe, J., Tonge, B. J., & Einfeld, S. L. (2016). The developmental trajectory of self-injurious behaviors in individuals with Prader Willi syndrome, Autism spectrum disorder and intellectual disability. Diseases, 4(1), 9.CrossRefGoogle Scholar
  33. Richards, C., Moss, J., Nelson, L., & Oliver, C. (2016). Persistence of self-injurious behavior in autism spectrum disorder over 3 years: a prospective cohort study of risk markers. Journal of Neurodevelopmental Disorders, 8(1), 1.CrossRefGoogle Scholar
  34. Richards, C., Oliver, C., Nelson, L., & Moss, J. (2012). Self-injurious behavior in individuals with autism spectrum disorder and intellectual disability. Journal of Intellectual Disability Research, 56(5), 476–489.CrossRefPubMedGoogle Scholar
  35. Richman, D. M., Barnard-Brak, L., Bosch, A., Thompson, S., Grubb, L., & Abby, L. (2013). Predictors of self-injurious behavior exhibited by individuals with autism spectrum disorder. Journal of Intellectual Disability Research, 57(5), 429–439.CrossRefPubMedGoogle Scholar
  36. Rojahn, J., Mulick, J. A., McCoy, D., & Schroeder, S. R. (1978). Setting events, adaptive clothing, and the modification of head banging and self-restraint in two profoundly retarded adults. Behavioral Analysis and Modification, 2, 185–196.Google Scholar
  37. Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., et al. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1735–1747.CrossRefPubMedGoogle Scholar
  38. Smith, R. G., Iwata, B. A., Vollmer, T. R., & Pace, G. M. (1992). On the relationship between self-injurious-behavior and self-restraint. Journal of Applied Behavior Analysis, 25, 433–445.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Sonuga-Barke, E.J.S. (2002). Psychological heterogeneity in AD/HD: A dual pathways model of motivation and cognition. Behavioral Brain Research, 130, 29–36.CrossRefGoogle Scholar
  40. Totsika, V., & Hastings, R. P. (2009). Persistent challenging behavior in people with an intellectual disability. Current Opinion in Psychiatry, 22, 437–441.CrossRefPubMedGoogle Scholar
  41. Turner, M. (1997). Towards an executive dysfunction account of repetitive behavior in autism. In J. Russell (Ed.), Autism as an executive disorder (pp. 57–100). Oxford: Oxford University Press.Google Scholar
  42. Turner, M. (1999). Annotation: Repetitive behavior in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40, 839–849.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Caroline Richards
    • 1
  • Louise Davies
    • 1
    • 2
  • Chris Oliver
    • 1
  1. 1.Cerebra Centre for Neurodevelopmental Disorders, School of PsychologyUniversity of BirminghamEdgbastonUK
  2. 2.Forward Thinking Birmingham Learning Disability TeamOaklands CentreSelly OakUK

Personalised recommendations