'I-28Sfuuy-WR10okMSia3VYeZTm2RHA2LZDel59TlF8' name='google-site-verification'/>www ghs.google.com 6dseurqgapmn gv-v6egtfduggmq3k.dv.googlehosted.com Autismwarriormama: About Autism and Self-injurious Behavior

Living with Autism


March 19, 2011

About Autism and Self-injurious Behavior

·         A 1991 National Institute of Health Consensus estimated 200,000 Americans with autism and other developmental disabilities suffer from severe, chronic self-injurious behaviors.

·         In 2002, California Department of Disabilities (DDS) reported there are 19,901 “self-injurious clients” in the state of California!!!  Hello! Didn't this sound the alarm bells? Didn't this immediately call for FUNDING for autism research into the causes and treatment for self injurious behavior in autism???

·         Annual cost of care to treat serious behavioral issues in developmentally-disabled is approximately $3 BILLION dollars. WHERE is this money going? Is it going to directly help the disabled? Or is it being spent to seminars, symposiums and in-house training, when realistically, these thing have nothing to do with directly helping the severely disabled clients these California Regional Centers serve. In fact, we find California's Regional Centers taking more and more parents to "Fair Hearings" when the parents fight for the child's right, under Lanterman Act, to get the services and supports they need. One would think a Regional center would support the parent's advocacy, right? Given the regional centers LIE to the media and public about what they do, right? Yep. Yes indeed, the media, 99.9% have NO CLUE how corrupt and compromised the regional centers are.

·         Providing In-Home-Health- Support-Services, and—even in more severe cases—state-funded home health care nursing services, dramatically REDUCES COST of care to society
·         Autistic individuals requiring 2:1 staffing, 24-hour protective supervision and complex medical and behavioral care, can cost taxpayers over 1 MILLION dollars a year when individual resides in state institution (often only place that will take them) compared to $75-000- $140,000 if living AT HOME with family members, and provided 24 hour, 1:1 LVN (licensed vocational nursing) or CHHA (certified home health aide) supports
·         Autistic persons suffering from chronic SIB are often behaviorally and neurologically fragile individuals
·         It is unknown how many autistics with chronic, treatment resistant SIB have ever been cured of this devastating behavior
·         SIB , it is rooted in, but not limited to, a complex mix of dopamine and serotonin dysfunction, hyper-arousal, communication deficits, hyper-or hypo sensitivity to pain, underlying acute or chronic medical issues, neurological dysfunction, nutritional imbalances, neurotransmitter dysfunction
·         Protective gear used to protect person from severe bodily injury includes, but is not limited to, boxing helmets, medically-prescribed temporary restraints, protective mitts, elbow and knee pads, hockey and football gear, face guards, gloves and the forever controversial skin-shock therapy

·          Antecedents to severe SIB are often multiple and can fluctuate daily. Sometimes the only reasonable sane solution is to provide 1:1 or 2:1 supports to protect the autistic person from self-harm. A right as per Lanterman Act. WIC CODE 4502. 
·         Behavioral analysis includes examining medical, behavioral and environmental issues and interviewing caregivers and relatives who share observations and ideas
·         Pro-active supports, include, but are not limited to, providing properly trained staff, exercise, diet, nutritional support, improving sleep patterns, health, comfort, physical protection, complex case management, swift interventions, are critical to treating self-injurious behaviors
·         No single cause is linked to the behavior (multiple antecedents)
·         No conventional drugs, outside of complete sedation, are known to completely halt severe, chronic self-injurious behavior
·         Drugs that block or activate one or more neurotransmitters involved in SIB seem critical in effective management and treatment of SIB
·         Drugs antagonizing D1-dopamine receptors, but not D2 receptors, have shown some success in treating certain individuals with chronic SIB
·         Might defects in D2 and D4 receptors be linked to SIB?
·         Elevated D1 and D4 receptors increases dopamine in prefrontal cortex and as such, may increase cognition
·         Drugs that block D2 and 5HT 2 receptors (ie…zyprexa) may reduce SIB
·         5-HT receptors can interact with dopamine receptors to reduce SIB, which illuminates SIB rooted in specific interactions of neurotransmitter systems in brain. (i.e...increasing serotonin in brain can mitigate debilitating affects of dopamine depletion. Depleted dopamine systems implicated in SIB.)
·         Might autistics with epilepsy have dysregulation of 5 HT1A  function?
·         5HT receptors influence sleep-wake cycles
·         5HT1A receptors affect impulsivity, addiction, anxiety, blood pressure, memory, mood, respiration, sleep, social skills, and nausea
·         5-HT 2a, 5HT 2c, 5HT 3, 5HT 6 and 5HT7 function would seem reasonable target receptors to further explore in treating chronic SIB in autistics
·         Autistics with SIB often have paradoxical or unusual reactions to pharmaceutical drugs. Given complex interactions of neurotransmitters, synthetic pharmacological agents, unreliability of generic versions of drugs, counterproductive side effects of drugs, and the hyper-sensitive function of autistic brains, this shouldn’t come as surprise.
·         Self-injury among people with autism tends to occur during, but not limited to, transition times, expectations (expects to go to school, but it’s vacation time), disruptions in routine (hospital visits), sudden loud noises, unfamiliar settings, hunger, thirst, abrupt changes in food preferences, likes and dislikes, frustration over demands (time to get dressed), discomfort (blisters, headache), sensory issues (bright lights, scratchy clothes), pain, boredom, sleepiness and overexcitement, illuminating, but not limited to, neurochemical dysregulation, impulse control, obsessive compulsive disorder and hyper-sensitivity of dopamine receptors induced by unique way some autistic persons view, what may very well be, an aversive world around them.
·         In cases where SIB fueled by multiple, fluctuating antecedents, and which multiple treatments and behavioral interventions have repeatedly failed, and self-inflicted bodily injury progresses , it is indicated and necessary to rule out undetected medical issues via head to toe analysis, including but not limited to ordering a whole-body MRI, fMRI, clinical examination of ear, nose and throat, blood tests to check for nutritional deficiencies and the ever controversial, and widely promoted by psychiatrist Dr. AMEN, PET scan.  “Oh, but the cost,” some cry. Think about cost of NOT finding underlying mechanisms fueling uncontrolled self-injurious behavior.
·         In extreme cases of SIB failing to respond to conventional treatments, consider ABA and adjunctive alternatives, including but not limited to, acupuncture, chiropractic care, herbal therapies, professional massage, hydrotherapy, music therapy, prayer, and special diets.
* Drugs that may help autistics who present with self injurious behavior rooted in hyperarousal, exaggerated startle response and/or dysregulation of adrenergic receptors may respond to Guanfacine,  Propopronol, Buspar or Clonidine. http://autism.healingthresholds.com/therapy/tenex-intuniv-guanfacine.
* Guanfacine (tenex) elevates PFC (pre-frontal cortex) working memory and has a lower side effect profile than clonidine.
* Propopronol (INN) increases cognition and has rapid onset, which is useful in acute cases of self-injurious behavior rooted in hyperarousal
* Achieving optimal physical and environmental health is of utmost importance in mitigating self injury among severely-autistics...ie...diet tailored to individual needs....providing setting that is tailored to individual needs....
*Hydrotherapy is an effective rescue intervention for some autistics who are prone to self-injury

Copyright © Kim Oakley 2011 All Rights Reserved

Disclaimer: Information provided for educational purposes only. Not intended to replace medical advice. Not for diagnostic or prescriptive use. Not for instruction on how to cure or treat any condition, illness or disease. Every individual is different, and what may work for one may not work for another. If you have a health concern, seek proper medical advice.

1 comment:

Karl said...

It's nice to know more about autism and self-injurious behavior. Thanks for sharing.

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