Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input

Summers, Jim; Shahrami, Ali; Cali, Stefanie; D’Mello, Chantelle; Kako, Milena; Palikucin-Reljin, Andjelka; Savage, Melissa; Shaw, Olivia; Lunsky, Yona

doi:10.3390/brainsci7110140

Cited by 77 publications

(54 citation statements)

References 85 publications

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“…Murray et al [] also observed higher psychotropic treatment rates in females with ASD in the UK. A multitude of other gender related, but unmeasured symptoms, such as functional social behavior, aggression or self‐injurious tendencies might also play a role in the choice of whether to initiate psychotropic treatment or not [Bresin & Schoenleber, ; Halladay et al, ; Summers et al, ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

2018

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Psychiatric comorbidities and use of psychotropic medications are common among patients with autism spectrum disorder (ASD). However, most previous research used data from the United States (US) and few studies have compared medication use in ASD to control groups, making contextualization of results difficult. In the United Kingdom (UK), general practitioners play a key role in the management of ASD. We conducted a retrospective, cross-sectional study over calendar year 2015, using primary care data from the UK. We identified a prevalent cohort of ASD cases (n = 10,856) and matched control groups of (a) general population (n = 21,712) and (b) attention deficit hyperactivity disorder (ADHD; n = 7,058) on age, sex and region. We described psychiatric comorbidities, psychotropic medications, and healthcare utilization in all three cohorts. Within the ASD cohort, we used multivariable logistic regression models to explore associations between patient characteristics and the outcomes of: any psychotropic medication, polypharmacy, and number of primary care visits. We used conditional logistic regression to compare the ASD and control groups. Psychiatric comorbidities were recorded for 41.5% of ASD patients; 32.3% received psychotropic medication and 9.8% received polypharmacy. Increased age and all psychiatric comorbidities (except conduct disorder) were associated with treatment use. Males were less likely to receive a treatment than females [Odds ratio (OR) 0.74 (0.66-0.83)]. ASD patients were more likely to take psychotropic medications than the general population ], but less likely compared to ADHD patients ]. Overall, rates of medication use in the UK were lower than those previously reported in the US.Lay Summary: We used electronic medical records from the UK, to describe the amount of psychiatric comorbidities, psychotropic medication use and healthcare resource use in ASD. Around one in three people with ASD were prescribed a psychotropic medication, which was more than the general population, but less than for those with ADHD. Increased age, psychiatric comorbidities and female gender were all independently associated with psychotropic medication use. Rates of medication use in the UK were lower than those previously reported in the US.

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Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

2018

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“…Our understanding of the factors that influence the presence and severity of self-injury within autism must be integrated with evidence-based models of the function and psychological mechanisms underpinning self-injury. For individuals with an intellectual disability, many of whom have co-morbid autism, the most influential and evidence-based explanatory model of self-injurious behaviour is derived from operant learning theory through an application of applied behaviour analysis (Summers et al 2017 ). Within this model, self-injury is understood to occur as a result of positive or negative reinforcement and can be mediated by contingencies in the individual’s social, sensory and material environment.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Self-injurious Behaviour in Autism: A Meta-analytic Study

Steenfeldt-Kristensen

Jones

Richards

2020

J Autism Dev Disord

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Self-injurious behaviour is purportedly common in autism, but prevalence rates have not yet been synthesised meta-analytically. In the present study, data from 14,379 participants in thirty-seven papers were analysed to generate a pooled prevalence estimate of self-injury in autism of 42% (confidence intervals 0.38-0.47). Hand-hitting topography was the most common form of self-injury (23%), self-cutting topography the least common (3%). Sub-group analyses revealed no association between study quality, participant intellectual disability or age and overall prevalence rate of self-injury. However, females obtained higher prevalence rates than males (p = .013) and hair pulling and self-scratching were associated with intellectual disability (p = .008 and p = .002, respectively). The results confirm very high rates of self-injury in autism and highlight within group risk-markers.

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“…These rhythmic and repetitive SIB are evaluated in studies of populations with both autism and intellectual disability (ID)/impaired adaptive functioning (Richards et al 2012 , 2016 ; Summers et al 2017 ; Baghdadli et al 2003 ; Weiss 2002 ). In these samples, SIB has predominantly been conceptualised within an operant learning framework (Summers et al 2017 ) as a response acquired and maintained through reinforcement and mediated by sensory and environmental contingencies. Yates ( 2004 ) proposed these “stereotyped SIB” displayed by autistic/ID samples differ categorically from “impulsive” self-harm displayed by neurotypical samples; however this theory was derived from a developmental psychopathology framework rather than empirical data and as such warrants further investigation.…”

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confidence: 99%

Prevalence and Risk-Markers of Self-Harm in Autistic Children and Adults

Licence

Oliver

Moss

et al. 2019

J Autism Dev Disord

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Self-harm is purportedly common in autistic individuals, but under-researched, particularly in younger samples and those without intellectual disability. This study aimed to describe prevalence, profile and correlates of self-harm in autistic individuals without impairments in adaptive functioning. Parents of autistic participants (n = 83) completed questionnaires regarding the presence/topography of self-harm, demographic characteristics, autism severity, age of diagnosis, affect, activity levels and repetitive behaviour. 24.10% of participants engaged in self-harm. Self‐harm was associated with significantly higher levels of impulsivity, over-activity, negative affect, compulsive behaviour and insistence on sameness. Low mood and overactivity/impulsivity predicted the presence of self-harm, with the model correctly classifying 82.9% of cases. Findings highlight a role for impaired behavioural inhibition and low mood in the aetiological mechanisms underpinning self-harm in autism.

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Self-Injury in Autism Spectrum Disorder and Intellectual Disability: Exploring the Role of Reactivity to Pain and Sensory Input

Cited by 77 publications

References 85 publications

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

The Prevalence of Self-injurious Behaviour in Autism: A Meta-analytic Study

Prevalence and Risk-Markers of Self-Harm in Autistic Children and Adults

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