Child and Adolescent Psychiatry Division, University of California at Los Angeles (UCLA) Geffen Medical School, Los Angeles, CA, USA.
Division of Child and Adolescent Psychiatry, University of California, San Francisco (UCSF) Weill Institute for Neurosciences, San Francisco, CA, USA.
J Intellect Disabil Res. 2018 Dec;62(12):1030-1042. doi: 10.1111/jir.12490. Epub 2018 Apr 25.
Self-injurious behaviours (SIB) are concerning, maladaptive behaviours that commonly occur in people with neurodevelopmental conditions and delays but seem to be particularly prevalent in children and adults with autism spectrum disorder (ASD). There has been increasing research examining the risk markers associated with the presence of SIB in people with ASD. Some of the factors associated with SIB have included cognitive abilities, adaptive functioning deficits and behaviour regulation impairments (e.g. impulsivity and repetitive behaviours). However, many of the findings in the literature are mixed and only explain a small proportion of the variance contributing to SIB. Limitations in the previous literature have centred on lack of availability of large and diverse samples, restricted age ranges and constraints of measurement.
This study characterises a clinic-referred sample of children and adults currently presenting with and without SIB using a range of standardised and parent-report measures. The sample includes 144 individuals with ASD between the ages of 2.5 and 60.1 years.
After adjusting for multiple tests, none of the variables maintained statistical significance between the group of individuals with and without SIB, but medium to large effect sizes were noted. These variables include parent-reported early motor and toileting delays and perinatal risk, and current cognitive and social impairment. The remaining variables, including current autism severity levels, early ASD symptomatology, impulsivity, executive functioning impairments, adaptive functioning, mood and anxiety, did not differ between those with and without current engagement in SIB.
Utilising a diverse clinic-referred sample and standardised diagnostic tools, this study explored retrospective and current correlate risk markers of SIB in individuals with ASD. In addition to impairments in current functioning, specific early developmental delays and perinatal risk factors were preliminarily associated with the presence of SIB in individuals with ASD. Together these findings suggest that a set of specific characteristics may be related to both early risk and concurrent manifestation of SIB. Identifying this set of characteristics in early development may lead to faster identification and better intervention services, but future work utilising longitudinal design and multivariate analysis is warranted.
自伤行为（SIB）是一种常见于神经发育障碍和发育迟缓人群的适应不良行为，但似乎在自闭症谱系障碍（ASD）患者中更为普遍。越来越多的研究探讨了与 ASD 患者 SIB 存在相关的风险标志物。与 SIB 相关的一些因素包括认知能力、适应功能缺陷和行为调节障碍（如冲动和重复行为）。然而，文献中的许多发现存在差异，只能解释导致 SIB 的一小部分变异。以前文献的局限性在于缺乏大型和多样化的样本、有限的年龄范围和测量的限制。
本研究使用一系列标准化和家长报告的测量工具，描述了目前有和没有 SIB 的临床就诊儿童和成人的样本特征。该样本包括 144 名年龄在 2.5 至 60.1 岁之间的 ASD 个体。
在调整了多项测试后，没有一个变量在有和没有 SIB 的个体之间具有统计学意义，但注意到中等至大的效应大小。这些变量包括家长报告的早期运动和如厕延迟以及围产期风险，以及当前的认知和社交障碍。其余变量，包括当前自闭症严重程度、早期 ASD 症状、冲动、执行功能障碍、适应功能、情绪和焦虑，在有和没有当前 SIB 参与的个体之间没有差异。
利用多样化的临床就诊样本和标准化诊断工具，本研究探讨了 ASD 个体 SIB 的回顾性和当前相关风险标志物。除了当前功能障碍外，特定的早期发育延迟和围产期风险因素与 ASD 个体 SIB 的存在初步相关。这些发现表明，一组特定的特征可能与早期风险和 SIB 的同时表现有关。在早期发育中识别出这组特征可能会导致更快的识别和更好的干预服务，但需要利用纵向设计和多变量分析的未来工作。
