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February 23, 2012

Self-Injurious Behavior in Autism Spectrum Disorder

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Self-injurious behavior is a hallmark feature of autism. Yet, unless it’s severe it’s often undiagnosed. Much like autism spectrum, there is a self-injurious behavior spectrum: Mild to Severe.

We find parents reporting self-injury among children with Aspergers:

  1. Jan 23, 2011 ... Moms and dads have a natural tendency to run to their Aspergers ... in a tantrum
    that cause them self-harm (e.g., banging head, hitting self, etc.)
    www.myaspergerschild.com/.../aspergers-temper-tantrums-15-tips-for.html
  2. Dec 20, 2010 ... Children and teens with Aspergers may engage in self-harming behaviors (also
    called ... What can be done to prevent self-injurious behavior?
    www.myaspergerschild.com/2010/12/aspergers-and-self-injury.html
  3. Nov 10, 2011 ... Individuals who engaged in self-injurious behaviors as children may return to
    these as adults during times of stress, illness or change.
    www.autism.org.uk/living-with.../self-injurious-behaviour.aspx  
We find Academy of Child and Adolescent Psychiatry website reporting self-injury among autism:

  1. Children diagnosed with autism tend to process and respond to information in the environment in unique ways. In some cases, parents are frightened because they exhibit aggressive and/or self-injurious behaviors which are difficult to manage…” http://www.aacap.org/cs/autism_resource_center/faqs_on_autism

We find Autism Society reporting: “Early Indicators: High Functioning Autism and Aspergers Syndrome… The disorder makes it hard to communicate and relate to the social world. In some cases, aggressive and/or SELF-INJURIOUS BEHAVIOR may be present (Autism Society of Delaware, 2005); Source: http://www.disabled-world.com/artman/publish/article_2255.shtml.



Because Aspergers individuals don’t possess a clinically significant cognitive delay and are of average or above average intellect, self-injurious behaviors often go unnoticed.
Self-injurious behaviors (ie… scratching arms, pulling hair, slapping or punching face) may occur in isolation. Or occur covertly, often triggered by high stress, bullying, sudden changes or being trapped in highly-illogical situations triggering extreme frustration.
For example, an Asperger’s man sitting in a meeting listening to something he can’t process, or finds inanely nonsensical, may hide arms under table and pinch himself. Or, later go into bathroom and yank hair. You’d never know it. Or a high-functioning autistic woman who is hyper-focusing on reading and constantly interrupted may, when the person interrupting leaves, slam fists into face. Thus, behavior may go unnoticed. In contrast, a severely-autistic individual—with more severe sensory and processing issues, let’s loose in any situation, by no fault of their own. Thus, it’s noticed.
SIB seen in higher functioning autistics differs in intensity, frequency and duration. For example, a severely-autistic child may hit head daily for several minutes. In contrast, an Asperger child may slap head five times once a week. In both cases, it’s self-injurious behavior.
Though there are differences between HF autism and LF (low functioning) autism, there seems a major connection with tendency to engage in self-injury. Hence, self-injurious behavior is a core feature of actual autism.

Here it is again mentioned: “Many symptoms that occur on the autism spectrum…severe anxiety and difficulty in communication…result in significant reduction of quality of life. More URGENTLY, certain symptoms such as self-injurious behavior represent an immediate danger of self harm.” http://www.aspergerssyndrome.org/PDF/AutismSubtypes.pdf

Clearly, self-injurious behavior exists across autism spectrum and as such, can no longer be ignored by researchers as being something else.

Of great interest is self-injurious behaviors among autistics DIFFER differ from other diagnostic groups.

Severely-autistic individuals tend to target above neck (head/face hitting, face slapping, face scratching and pulling hair). Higher functioning individuals also target head, as well as arms. Interesting, HEAD is major target, given autistic individuals often experience sensory overload and processing challenges rooted within brain, as if head hitting is natural reaction to incoming assaults and internal chaos.

Let’s compare self-injury seen in GENETIC conditions with self-injury seen in actual autism.  

Self-Injury seen in Cornelia de Lange syndrome presents as biting fingers and putting fingers in mouth.

Individuals with Rett Syndrome present with: hand wringing, hand mouthing and digging fingernails into opposite hand.

Individuals with Prader-Willi Syndrome present with obsessive skin-picking causing tissue damage.
Individuals with Lesch-Nyan present with eye-poking, tongue and cheek biting, head banging, nose gouging.   

Individuals with Fragile-X/Angelman’s syndrome may display SIB, but these are not true autism. These too are genetic conditions identified by distinctive characteristics and chromosomal abnormalities, thus separating them from actual autism.

Some researchers think autism is genetic. But there’s no concrete evidence. Until there is, we should contain what we know to be factual and logical about self-injurious behaviors among autistics and not swirl different diagnostic groups into autism behavioral research.

It would make sense to study together high and low functioning autistics who exhibit self-injurious behaviors to identify common underlying mechanisms fueling or triggering their SIB.
 
© Kim Oakley February 23, 2012
selbst verletzungen bei autismus

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