July 29, 2013 2:32 pm Published by QSAC
Did you check out our picture collage above? QSAC’s Residential Adult Clinical Department is proud to announce that we are currently conducting Life Skills Training Series in our Floral Park office. The training series consists of several modules that include Cooking School, Exercise and Coping Skills Training, Money Management class and Travel Training. Cooking school is a first module that recently started. It is a project that has been developed to help participants learn about cooking and the benefits of eating a variety of foods. The project is divided into 7 workshops that are designed to be practical and enjoyable, while teaching individuals important food related messages and skills.
July 8, 2013 12:19 pm Published by Francisco Monegro, Ph.D., M.D.
Seven workshops are designed in such way that each workshop is based around a different dish for a meal occasion, e.g. Super smoothie, Healthy salad, Fabulous fruit salad, etc. In each workshop a small group of participants develop knowledge and skills based around that dish. Participants are introduced to the recipe, list of ingredients, necessary utensils and equipment, specific safety precautions, and steps they need to follow to complete preparing a dish. A group instructor engages participants in discussion by using colorful educative visual tools, and by providing them with support and guidance while they have the hands-on experience.
Nevena Savic, MA
Repetitive/compulsive self-injurious behaviors (RSIBs), also known as Body-Focused Repetitive Behaviors (BFRBs), has been defined as a behavior or a group of behaviors, which are destructive or cause physical harm in terms of tissue damage. These non-functional behaviors toward the body are typically repetitive or rhythmic, and constant (Roberts, et al. 2013, Tureck, et al. 2013, Matson & Turygin 2012). According to Davies and Oliver’s study (2013), repetitive self-injurious behaviors and aggressive behaviors are the most prevalent challenging behaviors among individuals with intellectual disabilities (especially those who score in the severe to profound range), Fragile X and Autism Spectrum Disorder (ASD), and individuals with deficits in receptive and or expressive communication.
Repetitive/compulsive self-injurious behavior (RSIB) is a chronic disorder that often begins in early childhood. Some studies have identified a likelihood of increase in the prevalence of self-injurious behaviors with increased age and co-morbid diagnoses. Autism constitutes a high risk factor for repetitive self-injurious behaviors, which is unclear. The prevalence of SIB has been estimated in 30-50% of individuals with autism and 97% of individuals with SIB displayed concomitantly some forms of stereotyped motor behaviors (Baghdadli, et. al 2003, Gal et. al, 2009). The topography of the behaviors varies from mild self-harm to severe forms involving permanent and even life-threatening tissue damage (Wolff, et. al 2013).
According to Devine and Symons (2013), the literature concerning self-injurious behaviors is frequently confused between etiology and treatment efficacy. The best comprehensive way to understand repetitive self-injurious behavior is by assuming RSIB has a multitude of “environment-brain-behavior relationships.” Multiple vulnerability factors may be involved in repetitive self-injurious behavior (RSIB) such as deficits in emotional processing information, pain sensitivity, stereotypy behavior, anxiety symptoms, lack of communication skills and institutionalization. Several studies have associated repetitive/compulsive self-injurious behaviors with biological and genetic risk factors such as developmental age, clinical condition, sensory impairment, Lesch-Nyhan, Prader-Willi, Smith-Magenis, Fragile X, and Cornelia de Lange.
Frequently, repetitive self-injurious behaviors can cause tissue damage. However, knowledge about the sensory and nociceptive neurobiological basis is very limited. Symons and colleagues (2011) suggest that chronic SIB and altered pain experiences are also associated with a wide spectrum of neurological, psychiatric, and developmental disorders. There is evidence that pain pathways and pain amplification mechanisms may be altered, which might contribute to self-injurious behavior. However, more studies are necessary to evaluate the relationship between pain and self-injurious behavior (Peebles, 2012).
From the functional analysis point of view, the repetitive self-injurious behavior (RSIB) is usually present when an individual desires to escape a situation, avoid unpleasant activities, obtain tangible items or for attention. However, for a number of people with autism, social contingency relationships (reinforcement mechanisms) seem to not apply or are difficult to establish, making it difficult to design effective behavioral intervention.
Mood dysregulation (anxiety, depression, eating, and substance-related disorders) may be a risk factor as well as the relationship between emotion-regulation strategies (acceptance, avoidance, problem solving, reappraisal, rumination, and suppression) promoting repetitive self-injurious behaviors (RSIBs). According to Divine and Symons publication (2013), “abnormal basal activity and responsiveness of the limbic-hypothalamus-pituitary-adrenal (LHPA) axis” may be a common characteristic among many self-injurious behaviors. It has been reported that 50% of individuals with autism experience anxiety symptoms. According to the emotion regulation model, the behavior occurs as a response to the identification of emotional experiences (Roberts et al., 2013). Roberts and colleagues (2013) suggest that the individual seeks relief from or to alleviate negative emotions, which in turn reinforces and perpetuates the repetitive self-injurious behaviors. Therefore, given an individual’s inability to cope with the emotional state or to control the impulse, it is assumed that the repetitive self-injurious behavior is negatively reinforced because it provides an escape from undesired emotions or difficult events. Often individuals with repetitive self-injurious behaviors (RSIBs) may suffer from anxiety and mood dysregulation (Teng et al. 2004).
Currently, there is no proven effective pharmacological treatment for repetitive self-injurious behaviors. The data from Naltrexone studies (an opioid antagonist) to sensory aspects of repetitive self-injurious behaviors has been mixed. In a research study, Fontenot and colleagues (2009) compared Fluoxetine and Venlafaxine. Fluoxetine (Prozac) was most effective in reducing self-injurious behaviors than Venlafaxine (Effexor). In an animal model study, Calcium Channels Blockers such as Nifedipine (Procardia) suppressed the self-injurious behaviors. Anti-convulsive medications such as divalproex sodium (Depakote), Levetiracetam (Keppra), Topiramate (Topamax) and Zonisamide (Zonegran) (Deriaz, 2012, Triba, 2012) have shown some efficacy in reducing self-injurious behaviors. More studies are needed to understand the etiology, underlying pain, and sensory expression, as well as the role of co-morbid medical/psychiatric diagnoses and risk factors, to develop an effective treatment approach.
July 1, 2013 10:12 pm Published by Kristen DuMoulin, Ph.D.
A recent study published in the online issue of JAMA Psychiatry found that children with autism may have stronger functional connectivity between certain areas of the brain networks than typically developing children. Researchers observed dense interconnections within the salience network of the brain, which predicted autism classification in 83% of the sample as well as symptom severity, denser connectivity was exhibited in children with more severe restricted and repetitive behaviors.