How do researchers define self-injurious behavior?

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Abstract

Self-injurious behavior is commonly observed among persons with intellectual disabilities. However, a second parallel use of this term is used in the general mental health field for self-mutilation. The authors describe these two disorders and how they differ. Characteristics of what we refer to as repetitive self-injurious behavior among persons with intellectual disabilities and risk factors for these behaviors are discussed. We also describe different assessment/testing methods which aid in defining this phenomenon. The implications of these data for research and clinical practice are discussed.

Introduction

Intellectual disabilities (ID) and other developmental disabilities such as autism present with a number of problems (Fitzgerald et al., 2011, Hattier et al., 2011a, Hattier et al., 2011b, Horovitz and Matson, 2011, Smith and Matson, 2010a, Smith and Matson, 2010b). Among the difficulties are motor and communication problems (Mahan and Matson, 2011, Matson et al., 2011d, Sipes et al., 2011a), high rates of psychopathology (Horovitz et al., 2011b, Kozlowski et al., 2011b, Matson et al., 2011a, Matson and Shoemaker, 2011), feeding and toileting problems (Kozlowski et al., 2011a, Matson et al., 2011b), vocational problems (Kozlowski, Mahan, & Matson, 2010), social deficits (Mahan et al., 2010, Smith and Matson, 2010c), and challenging behaviors (Hattier et al., 2012, Matson et al., 2011f). These concerns dramatically affect the ability of the afflicted individual to integrate into the community. One of the most serious of these problems is self-injurious behavior (Kozlowski and Matson, 2012, Matson et al., 2012a, Sipes et al., 2011b). However, this particular term of art is used by various groups of researchers to describe very different phenomena. As a result, we are suggesting that the term repetitive self-injurious behavior be used to refer to what is generally considered self-injurious behavior in the developmental disabilities literature.

Section snippets

Tale of two definitions

The field of developmental disabilities has a definition of self-injurious behavior which consists of a range of topographies with a common set of characteristic. (1) The behavior causes physical harm, most commonly in the form of tissue damage versus poisoning or other types of self-harm. (2) The behavior is typically a repetitive, rhythmic movement. (3) The behavior is usually just that, a constant (e.g. hand to head over and over). (4) Frustration, anxiety, and the concomitant desire to

Characteristics

What are common factors associated with repetitive self-injurious behavior, and what constitutes some common risk factors? A number of studies have looked at common factors. For example, for very young children (17–36 months old) who had more symptoms of avoidance and tantrum/conduct symptoms were at higher risk for repetitive self-injurious behavior (Matson, Mahan, et al., 2011). Testing older children with autism up to 18 years old, McTiernan, Leader, Healy, and Mannion (2011) found high

Test/assessment methods

Repetitive self-injurious behavior is assessed in at least four ways: tissue examination, operational definitions, functional assessment, and standardized tests. Typically, more than one of these methods are used in combination. The most common combination would be the use of operational definitions with functional assessment. A brief review of each method and how they are used follows.

Standardized tests

A number of standardized tests have also been developed to evaluate repetitive self-injurious behavior. These measures tend to have a much different purpose. As noted earlier, challenging behaviors tend to occur in groups, and these scales spread a wide net and show covariation, and severity of a constellation of challenging behaviors. These measures are used to some extent to evaluate treatment outcomes, but this approach is less sensitive to treatment effects than the other methods reviewed.

Conclusions

Persons with developmental disabilities evince a wide range of problem behaviors and deficits (Matson et al., 2011e, Matson et al., 2009). These factors range from basic adaptive behaviors to high rates of psychopathology (Cherry et al., 1997, Matson et al., 1999b). At the forefront of these deficits, however, are challenging behaviors (Matson, Mahan, Sipes, & Kozlowski, 2010). Among the most problematic of this general group of behaviors are those responses described as self-injurious

References (72)

  • M. Horovitz et al.

    Developmental milestones in toddlers with atypical development

    Research in Developmental Disabilities

    (2011)
  • M. Horovitz et al.

    Incidence and trends in psychopathology symptoms over time in adults with severe to profound intellectual disability

    Research in Developmental Disabilities

    (2011)
  • A.M. Kozlowski et al.

    An examination of challenging behaviors in autistic disorder versus pervasive developmental disorder not otherwise specified: Significant differences and gender effects

    Research in Autism Spectrum Disorders

    (2012)
  • A.M. Kozlowski et al.

    The relationship between psychopathology symptom clusters and the presence of comorbid psychopathology in individuals with severe and profound intellectual disability

    Research in Developmental Disabilities

    (2011)
  • R. Lang et al.

    Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review

    Research in Developmental Disabilities

    (2010)
  • L.O. Lundqvist

    Psychometric properties and factor structure of the Behavior Problems Inventory (BPI-01) in a Swedish community population of adults with intellectual disability

    Research in Developmental Disabilities

    (2011)
  • S. Mahan et al.

    An examination of psychotropic medication side effects: Does taking a greater number of psychotropic medications from different classes affect presentation of side effects in adults with ID?

    Research in Developmental Disabilities

    (2010)
  • S. Mahan et al.

    Children and adolescents with autism spectrum disorders compared to typically developing controls on the Behavioral Assessment System for Children Second Edition (BASC-2)

    Research in Autism Spectrum Disorders

    (2011)
  • J.L. Matson et al.

    Autism diagnosis and screening: Factors to consider in scale development and differential diagnosis

    Research in Autism Spectrum Disorders

    (2012)
  • J.L. Matson et al.

    Scaling methods to measure psychopathology in persons with intellectual disabilities

    Research in Developmental Disabilities

    (2012)
  • J.L. Matson et al.

    Comorbid psychopathology factor structure on the Baby and Infant Screen for Children with aUtIsm Traits-Part 2 (BISCUIT-Part 2)

    Research in Autism Spectrum Disorders

    (2011)
  • J.L. Matson et al.

    The relationship of self-injurious behavior and other maladaptive behaviors among individuals with severe and profound intellectual disability

    Research in Developmental Disabilities

    (2008)
  • M.L. Matson et al.

    Comorbidity of physical and motor problems in children with autism

    Research in Developmental Disabilities

    (2011)
  • J.L. Matson et al.

    Additional considerations for the early detection and diagnosis of autism: Review of available instruments

    Research in Autism Spectrum Disorders

    (2011)
  • J.L. Matson et al.

    Characteristics of depression as assessed by the Diagnostic Assessment for the Severely Handicapped II (DASH-II)

    Research in Developmental Disabilities

    (1999)
  • J.L. Matson et al.

    Reliability and item content of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): Part 1–3

    Research in Autism Spectrum Disorders

    (2009)
  • A. McTiernan et al.

    Analysis of risk factors and early predictors of challenging behavior for children with autism spectrum disorder

    Research in Autism Spectrum Disorders

    (2011)
  • M. Sipes et al.

    Gender differences in symptoms of autism spectrum disorders in toddlers

    Research in Autism Spectrum Disorders

    (2011)
  • K.R.M. Smith et al.

    Psychopathology: Differences among adults with intellectual disability, and comorbid autism spectrum disorders, and epilepsy

    Research in Developmental Disabilities

    (2010)
  • K.R.M. Smith et al.

    Behavior problems: Differences among intellectually disabled adults with autism spectrum disorders and epilepsy

    Research in Developmental Disabilities

    (2010)
  • F.J. Symons et al.

    Evidence of increased non-verbal behavioral signs of pain in adults with neurodevelopmental disorders and chronic self-injury

    Research in Developmental Disabilities

    (2009)
  • D.J. Van Ingen et al.

    The Behavior Problems Inventory (BPI-01) in community based adults with intellectual disabilities: Reliability and concurrent validity vis-à-vis the Inventory for Client and Agency Planning (ICAP)

    Research in Developmental Disabilities

    (2010)
  • M. Weeden et al.

    Self-injurious behavior and functional analysis: Where are the descriptions of participant protections?

    Research in Developmental Disabilities

    (2010)
  • D.R. Banda et al.

    Decreasing self-injurious behavior in a student with autism and Tourette syndrome through positive attention and extinction

    Child and Family Behavior Therapy

    (2009)
  • E.M. Camp et al.

    Antecedent versus consequent events as predictors of problem behavior

    Journal of Applied Behavior Analysis

    (2009)
  • K.E. Cherry et al.

    Psychopathology in older adults with severe and profound mental retardation

    American Journal of Mental Retardation

    (1997)
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