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.
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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.
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.
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.
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.
Carr, E. G., & Blakeley-Smith, A. (2006). Classroom intervention for illness-related problem behavior in children with developmental disabilities. Behavior Modification, 30, 901–924.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Guess, D., & Carr, E. G. (1991). Emergence and maintenance of stereotypy and self-injury. American Journal on Mental Retardation, 96, 299–319.
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.
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.
King, B. (1993). Self-injury by people with mental retardation: A compulsive behavior hypothesis. American Journal on Mental Retardation, 98, 93–112.
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.
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.
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.
Melzack, R. & Wall, P. D. (1965). Pain Mechanisms - A New Theory. Science, 150, 971-&.
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.
O’Reilly, M. F. (1997). Functional analysis of episodic self-injury correlated with recurrent otitis media. Journal of Applied Behavior Analysis, 30, 165–168.
Oliver, C., Murphy, G., Hall, S., Arron, K., & Leggett, J. (2003). Phenomenology of self-restraint. American Journal on Mental Retardation, 108, 71–81.
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.
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.
Petty, J. (2006). Self-injurious behaviour in children with severe intellectual disabilities. Unpublished Ph.D. thesis.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Totsika, V., & Hastings, R. P. (2009). Persistent challenging behavior in people with an intellectual disability. Current Opinion in Psychiatry, 22, 437–441.
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.
Turner, M. (1999). Annotation: Repetitive behavior in autism: A review of psychological research. Journal of Child Psychology and Psychiatry, 40, 839–849.
This study was funded by Research Autism and Cerebra.
CR contributed to the design of the study, collected and analysed the data and drafted the manuscript. LD contributed to the design of the study and revised the manuscript. CO contributed to the design of the study and revised the manuscript. All authors read and approved the final manuscript.
Conflict of interest
Dr. Caroline Richards declares that she has no conflict of interest. Dr. Louise Davies declares that she has no conflict of interest. Professor Chris Oliver declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Richards, C., Davies, L. & Oliver, C. Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control. J Autism Dev Disord 47, 701–713 (2017). https://doi.org/10.1007/s10803-016-3000-5
- Autism spectrum disorder