Treatment Approaches for Self-Injurious Behavior in Individuals with Autism: Behavioral and Pharmacological Methods

Article excerpt

The most recent report published by the Centers for Disease Control (CDC) note the prevalence of autism to be approximately 1 out of every 150 live births with a male to female ratio of 4 to 1 (CDC, 2007). Autism is a heterogeneous neurodevelopmental disorder characterized by a wide array of symptoms but with some commonalities (Volkmar & Klin, 2005). Symptoms are primarily noted in three domains; specifically impairments in social interaction and communication, and engagement in repetitive behaviors.

Social interaction impairments may include the failure to develop appropriate peer relationships, lack of desire to share social enjoyments or interests, or lack of social reciprocity. Impairments in communication may include a delay in the development of spoken language, the ability to initiate or continue a conversation, stereotyped or repetitive use of language, or lack of spontaneous pretend play or social imitative play. Finally, those with autism may also engage in repetitive and stereotyped behavior such as abnormal preoccupation with one or more patterns of interest, the need for strict routines, preoccupation with parts of objects, repetitive motor mannerisms, and self-injurious behavior. Self-injurious behavior (SIB) is any harmful behavior that an individual inflicts upon himself/herself and is usually considered to be the most pressing issue facing individuals with developmental disorders or mental retardation, including autism (Barrera, Violo, & Graver, 2007; Dawson, Matson, & Cherry, 1998; Murphy, Hall, Oliver & Kissi-Debra, 1999; Newell, Sprague, Pain, Deutsch, & Meinhold, 1999). About 5 to 16 percent of individuals with mental retardation exhibit SIB (Richman & Lindauer, 2005) with the severity of the SIB correlated with the severity of the delay (Baghdadli, Pascal, Grisi & Aussilloux, 2003).

The etiology of autism and SIB are still being researched and debated. To date, there have been many candidate genes identified (e.g., SERT, MAOA, FOXP2) as potential causes of autism (Wassink, Brzustowicz, Bartlett, & Szatmari, 2004). Given the multitude of genes and the diversity of phenotypic expression, there is suggestion that the underlying cause of autism may vary across children. Similarly there are multiple behavioral and biological correlates that influence the onset of SIB. This paper specifically addresses the treatment of SIB focusing on behavioral and pharmacological methods. Within each of these methods there is a wide array of options that will be assessed. By reviewing all of these options we hope to provide an awareness of the treatment options available and provide a prompt for further research on effective treatments for SIB in individuals with autism.

Treatment of Self-injury in Autism

It is difficult to find one comprehensive course of treatment for autism as it is generally considered to be a heterogeneous disorder. Attempting to find comprehensive treatment for SIB is equally challenging as there may be multiple variables maintaining SIB--environmental and/or physiological Since is it hypothesized that in some cases, SIB may be the result of many interacting effects of genetics, biochemistry, and environment, understanding the behavioral and biological function of SIB may aid in the development of a treatment regimen, especially in those cases where SIB is treatment resistant, a common feature of SIB (Sandman, 1988).

Behavioral Treatment of Self-injurious Behavior

The foremost approach for the treatment of SIB in individuals with autism is behaviorally based. Research has demonstrated that for many individuals SIB is socially mediated warranting environmental modifications (Iwata, Pace, et al., 1994). Determining the function of SIB and selecting treatments based on these functions is paramount for successful treatment. Functional assessments allow for the identification of the relations between SIB and relevant antecedents and consequences on an individual basis (Iwata, Dorsey, Slifer, Bauman, & Richman 1982/1994; Iwata et al. …