Treatment of Self-injurious Behaviour in Children with Intellectual Disabilities

Definitions of self-injurious behaviour (SIB) generally describe such behaviour as comprising nonaccidental self-inflicted acts causing damage to or destruction of body tissue and carried out without suicidal ideation or intent (Yates, 2004). For the clinician working with children with severe intellectual disabilities, such behaviours are likely to be a frequent cause for concern. Between 4% and 12% of such children exhibit SIB (Oliver, Murphy, & Corbett, 1987), which may present as repetitive head banging or face slapping, self-biting to the hands or other parts of the body, removing scabs from old wounds, self-pinching or scratching, hair-pulling and eye-poking, often presented in multiple forms in the same child. Self-injury may emerge as early as 11–13 months of age (Berkson, Tupa, & Sherman, 2001; Hall, Oliver, & Murphy, 2001a), increases in prevalence and severity throughout the school-age years and young adulthood (Oliver et al. 1987), and once established in adulthood is likely to be chronic in nature (Emerson et al., 2001). Presentation of SIB is associated with a range of negative physical and social consequences (Emerson, 1992). Timely, comprehensive, and, where necessary, persistent intervention is therefore indicated when a child with intellectual disabilities presents with SIB. After discussing the range of treatment options currently available to the professional, this chapter briefly reviews recent research on the aetiology and developmental course of SIB and resulting implications for treatment.

Self-injury is seen in a wide variety of disorders (Bodfish & Lewis, 2002), and may be categorised as major, stereotypic, compulsive, or impulsive (Yates, 2004), distinctions which may be helpful in considering the general direction of strategies for assessment and treatment. Any attempt to treat SIB should be preceded by a prior comprehensive assessment (Vollmer, XXXX) covering social and medical contextual factors, history, phenomenology including comorbidity with other emotional and behavioural difficulties, and detailed assessment of functional relationships among SIB and antecedent and consequent environmental events. Detailed assessment is necessary in designing effective behavioural treatment and in considering possible psychopharmacological interventions. It may, however, often be useful to have an overview of possible underlying mechanisms or causes of SIB in a particular individual and a working hypothesis regarding causation, as preliminary treatment may need to be initiated quickly to prevent further injury.