Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, UK.
J Child Psychol Psychiatry. 2015 Oct;56(10):1042-54. doi: 10.1111/jcpp.12425. Epub 2015 Apr 28.
Self-injurious behaviour is shown by a significant minority of children with developmental delay and has a substantial impact on child and carer wellbeing. Characteristics such as a greater degree of intellectual disability, autism spectrum disorder, some genetic syndromes and repetitive and impulsive behaviours are positively associated with self-injury. Prevalence generally increases with age into midadulthood and the behaviour is notably persistent.
In this review, we discuss the dominant causal theory of self-injury which draws on the principles of operant learning. We evaluate the utility of this theory to account for all empirical observations of self-injury.
A model of self-injury is presented that extends a previous model described by Guess and Carr. The new model integrates child characteristics and operant learning principles in a phenotype × environment paradigm to explain the variance in developmental trajectory of the severity of self-injury.
Behaviour dysregulation, as evidenced by the associations between self-injury, self-restraint, repetitive and impulsive behaviours, is identified as potentially influencing the severity and persistence of self-injury. Risk markers for self-injury are identified and the extended model indicates points of intervention and highlights the possibility of risk-related, targeted early intervention. The need for increased training of practitioners in the delivery of demonstrably effective interventions for self-injury is identified.
发育迟缓儿童中有相当一部分存在自伤行为，这对儿童和照顾者的健康有很大影响。具有较高程度的智力残疾、自闭症谱系障碍、某些遗传综合征以及重复和冲动行为等特征与自伤行为呈正相关。自伤的普遍性通常会随着年龄增长到成年中期而增加，而且这种行为表现出明显的持续性。
在这篇综述中，我们讨论了自伤的主要因果理论，该理论借鉴了操作性学习的原则。我们评估了该理论在解释自伤所有经验观察结果方面的有效性。
提出了一种自伤模型，该模型扩展了 Guess 和 Carr 之前描述的模型。新模型将儿童特征和操作性学习原则整合到表型×环境范式中，以解释自伤严重程度的发展轨迹的变异性。
行为失调，表现为自伤、自我约束、重复和冲动行为之间的关联，被认为可能影响自伤的严重程度和持续性。自伤的风险标志物被确定，扩展的模型指出了干预的切入点，并强调了针对风险的早期干预的可能性。确定了需要增加对从业者进行经过验证的有效的自伤干预措施的培训。
