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Self-injurious behaviors in children and adolescents with autism spectrum disorder without intellectual disability

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Abstract

Self-injurious behavior (SIB) is a challenging behavior in autism, and some issues about this theme is still unclear, mainly in children and adolescents without intellectual disability. According to the behavioral analysis theoretical model, SIB can fulfill different roles. We conducted a systematic review in order to investigate the prevalence rates and risk factors according to the classification framework based on functional SIB analysis in this group of patients. MEDLINE, Embase, and PsycINFO were searched, and 14 papers fulfilled the criteria for further investigation, which corresponds to 7649 non-intellectually-impaired autistic individuals (82.3% males). The prevalence rates of SIB in the sample ranged between 10.1–70.5%; Besides, some variables, such as sociodemographic characteristics and ASD severity, were analyzed as risk factors according to age and type of SIB described in studies. We discuss our findings based on a novel classification model to contribute to the gaps in understanding this complex phenomenon.

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References

  • Adrian, M., Zeman, J., Erdley, C., et al. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39(3), 389–400.

    Article  PubMed  Google Scholar 

  • Aman, M. G., & Singh, N. N. (1986). Aberrant Behavior Checklist Manual. Slosson Publications.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual (5th ed.). American Psychiatric Association.

    Google Scholar 

  • Bagby, RM., Parker, JDA., Taylor, GJ. (1994). The twenty-item Toronto Alexithymia scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Res, 38 (1): 23–32.

  • Baghdadli, A., Pascal, C., Grisi, S., & Aussilloux, C. (2003). Risk factors for self-injurious behaviours among 222 young children with autistic disorders. Journal of Intellectual Disability Research, 47(8), 622–627.

    Article  PubMed  Google Scholar 

  • Baghdadli, A., Picot, M. C., Pry, R., Michelon, C., Burzstejn, C., Lazartigues, A., et al. (2008). What factors are related to a negative outcome of self- injurious behaviour during childhood in pervasive developmental disorders? Journal of Applied Research in Intellectual Disabilities, 21, 142–149.

    Article  Google Scholar 

  • Beavers, G. A., Iwata, B. A., & Lerman, D. C. (2013). Thirty years of research on the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 46, 1–21.

    Article  PubMed  Google Scholar 

  • Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451.

    Article  Google Scholar 

  • Bishop, S. L., Hus, V., Duncan, A., Huerta, M., Gotham, K., Pickles, A., et al. (2013). Subcategories of restricted and repetitive behaviors in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(6), 1287–1297.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cataldo, M. F., & Harris, J. (1982). The biological basis for self-injury in the mentally retarded. Analysis and Intervention in Developmental Disabilities, 2, 21–39.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Le Couteur, A., Lord, C., Rutter, M. (2003). Autism diagnostic interview revised. Los Angeles, CA: Western Psychological Services.

  • Crosby, A.E., Ortega, L., Melanson, C. (2011). Self-directed Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

  • Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., et al. (2003). Factor analysis of restricted and repetitive behaviors in autism using the Autism Diagnostic Interview-R. Child Psychiatry and Human Development, 34, 3–17.

    Article  PubMed  Google Scholar 

  • Dempsey, J., Dempsey, A. G., Guffey, D., Minard, C. G., & Goin-Kochel, R. P. (2016). Brief Report: Further Examination of Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 46(5), 1872–1879.

    Article  PubMed  Google Scholar 

  • Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., et al. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 2460–2470.

    Article  PubMed  Google Scholar 

  • Duerden, E. G., Card, D., Roberts, S. W., Mak-Fan, K. M., Chakravarty, M. M., Lerch, J. P., & Taylor, M. J. (2014). Self-injurious behaviours are associated with alterations in the somatosensory system in children with autism spectrum disorder. Brain Structure & Function, 219(4), 1251–1261.

    Article  Google Scholar 

  • Edmondson, A. J., Brennan, C. A., & House, A. O. (2016). Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. Journal of Affective Disorders, 191, 109–117.

    Article  PubMed  Google Scholar 

  • Fitzpatrick, S. E., Srivorakiat, L., Wink, L. K., Pedapati, E. V., & Erickson, C. A. (2016). Aggression in autism spectrum disorder: Presentation and treatment options. Neuropsychiatric Disease and Treatment, 12, 1525–1538.

    PubMed  PubMed Central  Google Scholar 

  • Flowers, J., Lantz, J., Hamlin, T., & Simeonsson, R. J. (2020). Associated Factors of Self-injury Among Adolescents with Autism Spectrum Disorder in a Community and Residential Treatment Setting. Journal of Autism and Developmental Disorders, 50, 2987–3004.

    Article  PubMed  Google Scholar 

  • Glenn, C. R., & Klonsky, E. D. (2011). One-year test-retest reliability of the Inventory of Statements about Self-Injury (ISAS). Assessment, 18, 375–378.

    Article  PubMed  Google Scholar 

  • Handen, B. L., Mazefsky, C. A., Gabriels, R. L., Pedersen, K. A., Wallace, M., Siegel, M., et al. (2018). Risk Factors for Self-injurious Behavior in an Inpatient Psychiatric Sample of Children with Autism Spectrum Disorder: A Naturalistic Observation Study. Journal of Autism and Developmental Disorders, 48, 3678–3688.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hill, A. P., Zuckerman, K. E., Hagen, A. D., Kritz, D. J., Duvall, S. W., Santen, J., et al. (2014). Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample. Research in Autism Spectrum Disorder, 8, 1121–1133.

    Article  Google Scholar 

  • Hunsche, M.C., Saqui, S., Mirenda, P., Zaidman-Zait, A., Bennett, T., Duku, E., et al. (2020). Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study. J Autism Dev Disord. doi: https://doi.org/10.1007/s10803-020-04373-y. Online ahead of print.

  • Hyman, S. L., Fisher, W., Mercugliano, M., & Cataldo, M. F. (1990). Children with self-injurious behavior. Pediatrics, 85, 437–441.

    Article  PubMed  Google Scholar 

  • Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994a). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197–209.

    Article  PubMed  PubMed Central  Google Scholar 

  • Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., et al. (1994b). The functions of self-injurious behavior: An experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27, 215–240.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kerwin, M. E., Eicher, P. S., & Gelsinger, J. (2005). Parental Report of Eating Problems and Gastrointestinal Symptoms in Children with Pervasive Developmental Disorders. Children’s Health Care., 34, 217–234.

    Article  Google Scholar 

  • Kim, S.H., Lord, C. (2011). Autism Diagnostic Observation Schedule. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY.

  • Kolevzon, A., Lim, T., Schmeidler, J., Martello, T., & Cook, Jr. (2014). EH, Silverman JM. Self-injury in autism spectrum disorder: An effect of serotonin transporter gene promoter variants. Psych Research, 220, 987–990.

    Article  Google Scholar 

  • Lam, K. S. L., & Aman, M. G. (2007). The Repetitive Behavior Scale-Revised: Independent validation in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 855–866.

    Article  PubMed  Google Scholar 

  • Laverty, C., Oliver, C., Moss, J., Nelson, L., & Richards, C. (2020). Persistence and predictors of self-injurious behaviour in autism: A ten-year prospective cohort study. Molecular Autism, 11, 8.

    Article  PubMed  PubMed Central  Google Scholar 

  • LeBlanc, L. A., Patel, M. R., & Carr, J. E. (2000). Recent advances in the assessment of aberrant behavior maintained by automatic reinforcement in individuals with developmental disabilities. Journal of Behavior Therapy and Experimental Psychiatry, 31, 137–154.

    Article  PubMed  Google Scholar 

  • Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Ioannidis, J.P.A. et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 339: b2700

  • Maddox, B. B., Trubanova, A., & White, S. W. (2016). Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder. Autism, 21, 412–422.

    Article  PubMed  Google Scholar 

  • Matson, J. L., & Turygin, N. C. (2012). How do researchers define behaviour? Research in Developmental Disabilities., 33, 1021–1026.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Boisjoli, J., Rojahn, J., & Hess, J. (2009). A factor analysis of challenging behaviors assessed with the Baby and Infant Screen for Children with Autistic Traits (BISCUIT-Part 3). Research in Autism Spectrum Disorders, 3, 714–722.

    Article  Google Scholar 

  • McTiernan, A., Leader, G., Healy, O., & Mannion, A. (2011). Analysis of risk factors and early predictors of challenging behavior for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 5(3), 1215–1222.

    Article  Google Scholar 

  • Minshawi, N. F., Hurwitz, S., Fodstad, J. C., Biebl, S., Morriss, D. H., & McDougle, C. J. (2014). The association between self-injurious behaviors and autism spectrum disorders. Psychology Research and Behavior Management, 7, 125–136.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. (2009). PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6:e1000097.

  • Muskett, A., Capriola-Hall, N. N., Radtke, R. S., Factor, R., & Scarpa, A. (2019). Repetitive behaviors in Autism Spectrum Disorder: Associations with depression and anxiety symptoms. Research in Autism Spectrum Disorders., 68, 101449.

    Article  Google Scholar 

  • Neimy, H., Pelaez, M., Carrow, J., Monlux, K., & Tarbox, J. (2017). Infants at risk of autism and developmental disorders: Establishing early social skills. Behav Dev Bull, 22, 6–22.

    Article  Google Scholar 

  • Neuhaus, E., Bernier, R. A., Tham, S. W., & Webb, S. J. (2018). Gastrointestinal and Psychiatric Symptoms Among Children and Adolescents with Autism Spectrum Disorder. Frontiers in Psychiatry, 9, 515.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nissen, J. M., & Haveman, M. J. (1997). Mortality and avoidable death in people with severe self-injurious behaviour: Results of a Dutch Study. Journal of Intellectual Disability Research, 41, 252–257.

    Article  PubMed  Google Scholar 

  • Norman, H., & Borrill, J. (2015). The relationship between self-harm and alexithymia. Scandinavian J Psychol., 56, 405–419.

    Article  Google Scholar 

  • Norman, H., Oskis, A., Marzano, L., Coulson, M. (2020). The relationship between self-harm and alexithymia: a systematic review and meta-analysis. Scand J Psychol, Jul 24. doi:https://doi.org/10.1111/sjop.12668. Online ahead of print.

  • Oliver, C., Adams, D., Allen, D., Bull, L., Heald, M., Moss, J., et al. (2013). Causal models of clinically significant behaviors in Angelman, Cornelia de Lange, Prader-Willi and Smith-Magenis syndromes. International Review of Research in Developmental Disabilities, 44, 167–212.

    Article  Google Scholar 

  • Rattaz, C., Michelon, C., & Baghdadli, A. (2015). Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. Journal of Intellectual Disability Research, 59(8), 730–740.

    Article  PubMed  Google Scholar 

  • Richards, C., Davies, L., & Oliver, C. (2017). Predictors of self-injurious behavior and self-restraint in autism spectrum disorder: Towards a hypothesis of impaired behavioral control. Journal of Autism and Developmental Disorders, 47(3), 701–713. https://doi.org/10.1007/s10803-016-3000-5

  • Richards, C., Jones, C., Groves, L., Moss, J., & Oliver, C. (2015). Prevalence of autism spectrum disorder phenomenology in genetic disorders: A systematic review and meta-analysis. Lancet Psychiatry, 2, 909–916.

    Article  PubMed  Google Scholar 

  • Richards, C., Moss, J., Nelson, L., & Oliver, C. (2016). Persistence of self-injurious behaviour in autism spectrum disorder over 3 years: A prospective cohort study of risk markers. Journal of Neurodevelopmental Disorders, 8, 21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Richman, D. M., & Lindauer, S. E. (2005). Longitudinal assessment of stereotypic, proto-injurious, and self-injurious behavior exhibited by young children with developmental delays. American Journal on Mental Retardation, 110, 439–450.

    Article  PubMed  Google Scholar 

  • Rojahn, J., Matson, J. L., Lott, D., Esbensen, A. J., & Smalls, Y. (2001). The Behavior Problems Inventory: An instrument for the assessment of self-injury, stereotyped behavior, and aggression/destruction in individuals with developmental disabilities. Journal of Autism and Developmental Disorders, 31, 577–588.

    Article  PubMed  Google Scholar 

  • Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.

    Article  PubMed  Google Scholar 

  • Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Robinson, C., Carpenter, L., Giarelli, E., Lee, L. C., Wiggins, L. D., Durkin, M. S., & DiGuiseppi, C. (2016). Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder-A Population-Based Study. Journal of Autism and Developmental Disorders, 46(11), 3607–3614.

    Article  PubMed  PubMed Central  Google Scholar 

  • Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Rosenberg, C. R., Carpenter, L., Lee, L. C., Giarelli, E., Wiggins, L. D., Durkin, M. S., Reynolds, A., & DiGuiseppi, C. (2017). Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorder: Findings from Two Large National Samples. Journal of Autism and Developmental Disorders, 47(2), 285–296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Soke, G. N., Rosenberg, S. A., Rosenberg, C. R., Vasa, R. A., Lee, L. C., & DiGuiseppi, C. (2018a). Brief Report: Self-Injurious Behaviors in Preschool Children with Autism Spectrum Disorder Compared to Other Developmental Delays and Disorders. Journal of Autism and Developmental Disorders, 48(7), 2558–2566.

    Article  PubMed  PubMed Central  Google Scholar 

  • Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T. E., Rosenberg, C. R., Carpenter, L., Lee, C. L., Giarelli, E., Wiggins, L. D., Durkin, M. S., & DiGiuseppe, C. (2019). Prenatal, perinatal, and neonatal factors associated with self-injurious behaviors in children with autism spectrum disorder. Research in Autism Spectrum Disorder, 61, 1–9.

    Article  Google Scholar 

  • Soke, G. N., Rosenberg, S. A., Rosenberg, C. R., Vasa, R. A., Lee, L. C., & DiGuiseppi, C. (2018). Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development. Autism: the international journal of research and practice22(5), 625–635.

  • Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of non-suicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Lifethreatening Behavior, 44, 273–303.

    Article  Google Scholar 

  • Troyb, E., Knoch, K., Herlihy, L., Stevens, M. C., Chen, C., Barton, M., et al. (2016). Restricted and Repetitive Behaviors as Predictors of Outcome in Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 46, 1282–1296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Warnick, E. M., Bracken, M. B., & Kasl, S. (2007). Screening efficiency of the child behavior checklist and strengths and difficulties questionnaire: A systematic review. Child and Adolescent Mental Health, 2007(13), 140–147.

    Google Scholar 

  • Wilcox, H. C., Arria, A. M., Caldeira, K. M., et al. (2012). (2012) Longitudinal predictors of past-year non-suicidal self-injury and motives among college students. Psychological Medicine, 42(4), 717–726.

    Article  PubMed  Google Scholar 

  • Yeates, M. T. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychology Review, 24(1), 35–74.

    Article  Google Scholar 

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Figueiredo, T., Bernardes, C. & Serra-Pinheiro, M.A. Self-injurious behaviors in children and adolescents with autism spectrum disorder without intellectual disability. Curr Psychol 42, 9999–10011 (2023). https://doi.org/10.1007/s12144-021-02299-x

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