one’s own bodyinjurious behaviors are one of the most concerning forms of lower-level repetitive stereotypic behaviors (RSB) (Bishop and Kleinke, 2007).
Self-injurious behaviors in autism have multiple topographies with different biochemical and social environment causes and effects. The most common topographies of these behaviors include, but are not limited to head-banging, head-hitting, face-punching/slapping, hand-biting and excessive self-rubbing and scratching (Edelson, 1999;
Self-injurious behaviors (with restricted pattern of behaviors), movement disorders and cognitive deficits have been associated with developmental, neurological, psychiatric and genetic disorders (Bodfish & Lewis, 2002).
Disorders associated with self-injurious behaviors
Developmental disorders | Neurological disorders | Psychiatric disorders | Genetic disorders |
Mental retardation | Tourette’s syndrome | personality disorders | Lesch-Nyhan syndrome |
Autism | neuroacanthocytosis | eating disorders | Prader-Willi syndrome |
frontal-lobe epilepsy | schizophrenia | Rett syndrome | |
trichotillomania | Cornelia de Lange syndrome | ||
onychophagia | Smith-magenis syndrome | ||
Fragile X syndrome | |||
(Bodfish & Lewis, 2002) | |||
Individuals with developmental disabilities injure themselves for different reasons, which require diffrerent treatments. Self-injurious behaviors may be a result of over-arousal (e.g. frustration) and self-stimulatory or stereotypic behaviors. They engage in this type of behavior to obtain attention from other people (Iwata et al., 1993), and escape or avoid a task. Furthermore, it may be due to hypersensitivity to certain sounds in the environment, communication deficits; seizure activity in the frontal and temporal lobes (Gedye, 1989; Gedye, 1992); congenital brain disorder, neurochemical dysregulation (e.g. dopaminergic mechanisms, serotonergic transmission, GABA, and imbalance in the engogenous opiod system), and health conditions (e.g. otitis media, sleep deprevation, menses, gastroensophageal reflux disease), and anxiety-provoking events, which may resemble processes in people with panic attack disorder (e.g. hyperventilation, tachycardia, perspiration) (Stein & Neihaus, 2001; Thompson & Caruso, 2002).
Unfortunately, there is not a single treatment for self-abusive behaviors. The most effective treatments for both self-abusive behaviors and aggressive behavior have been based on a multi-model approach that includes applied behavior analysis (
The psychopharmacologic agents used to treat self-abusive behaviors include neuroleptics, sedative-hypnotics (barbiturates), stimulants (d-amphetamine, methylphenidate), antianxiety drugs, antidepressants and mood stabilizers, anticonvulsants, antihypertensives and opiate antagonists.
There is some evidence that neuroleptic agents are beneficial in treating some individuals with developmental disabilities and aggressive behaviors, but there is no solid evidence of the efficacy of neuroleptic agents in self-injurious behaviors. However, the second-generation antipsychotics, which have effects on both the serotonin (5-HT2) and dopamine (D2) systems, have been used in controlling autistic symptoms (Rojahn & Esbensen, 2002). On
Other medications used to treat symptoms associated with autism including stereotypic and or impulsive self-abusive behaviors are selective serotonin reuptake inhibitors (SSRIs) such as are Fluoxetine (Prozac) and sertraline (Zoloft). Although the
In a few studies, Lithium Carbonate has been suggested to be beneficial in treating individuals who have autism with mood dysregulation disorder and display self-injurious behaviors or aggressive behaviors. Anticonvulsant such as Depakote, Trileptal, Lamictal and Tegretol have also been widely used in controlling autistic symptoms including assaultive or self-injurious behavior. Beta-adrenergic blocking agents such as Propranolol, Nadolol and Pindolol have been reported in a few studies to reduce rage-related reactions, aggression and self-abusive behaviors (Tsiouris & Brown, 2004); however, there is no clinical trials reported in individuals with autism. Other studies suggest that alpha-adrenergic agonists, such as Clonidine and Guanfacine, may be useful for symptoms such as irritability and hyperactivity, but not for restricted stereotypic behaviors (RSBs) with self-abusive behaviors. Opiate antagonists theory has shown promise in treating self-abusive behaviors; however, clinical studies of opiate antagonists such as Naloxone and Naltrexone, which block the effects of endogenous opiates, have yielded conflicting results (Thompson & Caruso, 2002; Sandman & Touchette, 2002).
Multi-drug therapy for self-injurious behaviors and autism depends on associated comorbid conditions and the neurochemical phenotypes of autistic individual. Although there are some pharmacological treatment options for individuals with autism with associated symptoms of stereotypic or impulsive self-injurious, more therapeutic alternatives are being explored. The National Institutes of Health is evaluating self-injurious behaviors in mental retardation and autism. They are testing the effectiveness of new treatments with transcutaneous electric nerve stimulation (TENS), NeuroModulation Technique (NMT), Naltrexone, Abilify (Aripiprazole) and D-Cycloserine. The purpose of these studies is to determine whether they are effective in reducing maladaptive behaviors.
6 comments:
I eliminated severe head banging in my severely autistic son by giving him Vitamin C every day. He had bashed about 20 holes in the walls of my house with his head and , as soon as I added the Vitamin C, the head banging ceased. That was 5 years ago and it never returned.
My son also used to bite his arms and hands for hours every day. He seemed to be in physical pain. This went on for a few years, during which he was being chelated. The biting diminished rapidly upon increasing his daily dose of fish oil and giving him milk thistle daily. It is not gone but now only happens about once every two weeks for a couple of minutes instead of being a multiple daily event.
Thank you very much for sharing your interesting experiences. Deshpande, Dhir & Kulkarni (2006) report that mice exposed to high dose of Vitamin C (Ascorbic Acid) had less stereotyped behavior and more stereotyped behavior when they were treated with a lower dose of vitamin C. In addition, it seems that mega doses of vitamin C enhance the effects of some psychiatric drugs, including haloperidol (Haldol) (Pierce, Rowlett, Bardo and Rebec, 2005). The National Institutes of Health were conducting several investiagions to evaluate the effect of dietary supplementation using zinc and vitamin C, and the impaired methylation and antioxidant/detoxification capacity and chronic oxidative stress on children with autism. However, it appears that we need more randomized, double blind and placebo control studies before to draw any solid conclusion about the benefits of any dietary supplement.
It seems ludicrous that medical professionals still guess what drug may help an autistic person with severe intraccable self injurious behavior. I mean, this is just lame. Unethical and sloppy medicine. You can't possibly come close to finding the right medications to stop this nightmare behavior until you look at the person's brain function to see if there is hypo or hyper areas of functioning among the serotonin and dopamine systems as well as abnormal activitations in brain regions. Again, can you imagine a heart surgeon doing surgery on a person without having a clue where or what he's doing before he goes in? Or a pediatrician that just guesses where the baby is and hopes for the best when it's born....well, for some reason it's still OK to allow thousands of severely autistic persons with chronic self injurious behavior to SUFFER in the midst of years and years and years of doctors GUESSING from a drive by analysis, what of the 156 choices they have of drugs to treat SIB, may work. Gee, let's think about this, within about 18 years, you're looking at one dead person who probably smashed the hell outta their skull or ripped skin off their body while people were guessing which drug might help the autistic self abusing brain. ANY patient with autism and chronic self injurious behavior should have a SPECT scan of brain to evaluate where the heck the brain needs fixing and adjusting so you can then target that area with the proper drug therapies and not be wasting time and lives.
It seems ludicrous that medical professionals still guess what drug may help an autistic person with severe intraccable self injurious behavior. I mean, this is just lame. Unethical and sloppy medicine. You can't possibly come close to finding the right medications to stop this nightmare behavior until you look at the person's brain function to see if there is hypo or hyper areas of functioning among the serotonin and dopamine systems as well as abnormal activitations in brain regions. Again, can you imagine a heart surgeon doing surgery on a person without having a clue where or what he's doing before he goes in? Or a pediatrician that just guesses where the baby is and hopes for the best when it's born....well, for some reason it's still OK to allow thousands of severely autistic persons with chronic self injurious behavior to SUFFER in the midst of years and years and years of doctors GUESSING from a drive by analysis, what of the 156 choices they have of drugs to treat SIB, may work. Gee, let's think about this, within about 18 years, you're looking at one dead person who probably smashed the hell outta their skull or ripped skin off their body while people were guessing which drug might help the autistic self abusing brain. ANY patient with autism and chronic self injurious behavior should have a SPECT scan of brain to evaluate where the heck the brain needs fixing and adjusting so you can then target that area with the proper drug therapies and not be wasting time and lives. Sorry if I seem angry but I'm disgusted reading the plethora of repetitive abstract, ridiculous research about autism and self injurious behavior that does little to help the autistics right now who are smashing their fists into their heads, ripping hair, poking eyes or throwing heads into walls. The world does NOT need another research study or grant money given to some group of people who will spit out the same useless information about autism and self injurious behavior again and again and again, as if they are OCD and stuck on doing nothing to solve this very complex problem. Nothing will be solved in this area until the brain of each individual is carefully and compassionately looked at via a SPECT and doctors then analyze which drugs will target the areas that are triggering and/or fueling SIB.
The problem is with western medicine and their belief in feeding pills to everyone, who has an imbalance in certain parts of their brain. Through the previous post of Foresam he demonstrates that pills aren't enough sometimes. He was able to give him a simple home remedy of Vitamin C everyday to stop the head banging. All this proves is that we have to change our way of thinking towards disabilities, and give people with these disorders more brain-scans to establish the core of the problem.
one cousin start experiencing self injurious behaviors the day her father died .first she faint several times that day and after she started beating her left laps with her left hand with such a speed for hours.she was seeing a neurologist but this went on for few months.the beating diminish as soon as she start applying red wine all over her body.
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