The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities

doi:10.1016/j.ridd.2008.06.003

Research in Developmental Disabilities

Volume 30, Issue 2, March–April 2009, Pages 342-352

https://doi.org/10.1016/j.ridd.2008.06.003 Get rights and content

Abstract

We assessed whether the stereotyped movements (SM) that are a defining characteristic of autism are discriminable from those observed in other disorders, and whether stereotyped self-injurious movements, which are excluded as exemplars of SM in DSM-IV, differ from other SM in severity or in kind. We used the Stereotyped and Self-Injurious Movement Interview to assess self-injurious and other SM in children with autism (n = 56), intellectual disability (n = 29), vision impairment (n = 50), or hearing impairment (n = 51) and in typical children (n = 30). Cross-tabulation of scores indicated that self-injurious behavior is rarely performed in the absence of other SM. Reliability analyses indicated that patterns of covariation among SM items differ across groups so that different item sets are necessary to reliably measure SM in each group. Analyses of variance indicated the autism group exceeded one or more other groups in the frequency of 15 SM, the vision impaired group exceeded others on 5 SM, and the hearing impaired group exceeded others on 1 SM. Discriminant function analysis of SM items indicated that although only 66% of participants were accurately classified, it was rare for a child with a different disorder to be misclassified as having autism or visual impairment. We concluded that self-injurious behavior is a more severe form of SM, and there is a distinctive pattern of SM, including self-injurious behavior, that characterizes children with autism.

Section snippets

Participants and procedure

Participants were recruited after this project had been approved by the Human Research Ethics Committee of Curtin University of Technology. Participants were 221 children (129 boys, 92 girls) aged 6–13 years (mean = 9.40, S.D. = 1.81) comprising five groups: typical children (n = 30, boys = 14, mean age = 8.75, S.D. = 1.64), children with intellectual disabilities (n = 29, boys = 17, mean age = 10.35, S.D. = 2.02), children with visual impairments (n = 50, boys = 25, mean age = 9.02, S.D. = 1.59), children with hearing

Relationships between scoring methods

We began our analyses by assessing the extent to which the different scoring procedures produce non-redundant information by calculating Pearson correlations between the different scores. The correlations were so strong that the different scoring systems were essentially interchangeable. For stereotyped body movement items, correlations between scoring procedures ranged from r = .88 (between prevalance and duration scores) to r = .95 (between prevalence and repetitiveness scores). For stereotyped

Discussion

Our aims were to assess whether there are distinctive patterns of self-injurious and other SM among persons with autism and other disorders in which SM are common and, within each sample, to assess whether relationships between self-injurious SM and other SM were consistent with self-injurious behavior being regarded as part of the same class of behavior as other SM. The answer to both questions appears to be positive.

Acknowledgements

This research was supported by an Australian Postgraduate Award. Thanks to Michelle Turner who generously allowed us to adapt her “Repetitive Behaviours Interview.”

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RRD resulting from SIB poses therapeutic challenges because of limited patient cooperation, bilateral involvement, chronicity, and ongoing trauma in vulnerable and neglected patients. The surgical success rates were some of the lowest in the modern retinal detachment literature. The use of an SB may result in better outcomes, and visual function can be restored in some patients.
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Stereotyped movements (“stereotypies”) are semi-voluntary repetitive movements that are a prominent clinical feature of autism spectrum disorder. They are described in first-person accounts by people with autism as relaxing and that they help focus the mind and cope in overwhelming sensory environments. Therefore, we generally recommend against techniques that aim to suppress stereotypies in individuals with autism. Further, we hypothesize that understanding the neurobiology of stereotypies could guide development of treatments to produce the benefits of stereotypies without the need to generate repetitive motor movements. Here, we link first-person reports and clinical findings with basic neuroanatomy and physiology to produce a testable model of stereotypies. We hypothesize that stereotypies improve sensory processing and attention by regulating brain rhythms, either directly from the rhythmic motor command, or via rhythmic sensory feedback generated by the movements.
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This review summarizes motor stereotypies in terms of description, prevalence, pathophysiology, diagnosis and management. They are fixed and persistent movements. Stereotypies begin before 3 years of age and continue into adulthood. Primary motor stereotypies occur in children of normal intelligence, whereas secondary stereotypies ensue in the setting of an additional diagnosis such as autism spectrum disorder or other neurologic disorders. They are highly associated with comorbidities such as anxiety, obsessive-compulsive symptoms, inattention, and tics. The pathophysiology of stereotypies involves fronto-striatal overactive dopaminergic pathways, and underactive cholinergic and GABAergic inhibitory pathways. No genetic markers have been identified despite a clear genetic predisposition. Behavioral therapy is the principle treatment. Future studies will focus on identifying genetic markers, and on better understanding the functional and structural neurobiology of these movements.

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The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities

Abstract

Section snippets

Participants and procedure

Relationships between scoring methods

Discussion

Acknowledgements

Brain Development

Research in Developmental Disabilities

Research in Developmental Disabilities

Research in Developmental Disabilities

Behaviour Research & Therapy

Journal of Applied Psychology

The scarred soul: Understanding and ending self-inflicted violence

Diagnostic and statistical manual of mental disorders (DSM-IV-TR)

Mental retardation: Nature, cause, and management

Stereotyped acts

Self-injurious behaviour

Repetitive stereotyped behaviours

The American Journal of Mental Deficiency

Varieties of repetitive behavior in autism: Comparisons to mental retardation

Journal of Autism & Developmental Disorders

Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions

American Journal of Orthopsychiatry

Head banging in early childhood

The Journal of Pediatrics

Bodies under siege: Self-mutilation and body modification in culture and psychiatry

Sensory differences and stereotyped movements in children with autism

Behaviour Change

A review of treatment research for self-injurious and stereotyped responding

Journal of Mental Deficiency Research