Classification of self‐injurious behaviour across the continuum of relative environmental–biological influence

Abstract

Self-injurious behaviour (SIB) is generally considered to be the product of interactions between dysfunction stemming from the primary developmental disability and experiences that occasion and reinforce SIB. As a result of these complex interactions, SIB presents as a heterogeneous problem. Recent research delineating subtypes of SIB that are nonsocially mediated, including one that is amenable to change and one that is highly invariant, enables classification of SIB across a broader continuum of relative environmental-biological influence. Directly examining how the functional classes of SIB differ has the potential to structure research, will improve our understanding this problem, and lead to more targeted behavioural and pharmacological interventions. Recognising that SIB is not a single entity but is composed of distinct functional classes would better align research with conceptual models that view SIB as the product of interactions between environmental and biological variables.

Identifying predictive behavioral markers: A demonstration using automatically reinforced self‐injurious behavior

“…As noted previously, differences across subtypes suggests that ASIB probably should not be considered a single category, and highlights the need to better understand and develop more effective interventions for Subtype‐2 ASIB. Although Subtype‐1 ASIB appears generally homogenous, the observed heterogeneity of Subtype‐2 in terms of the variation in the level of differentiation in the functional analysis and the widely diverse response to treatment raises questions about whether Subtype‐2 ASIB represents a single subcategory (Hagopian et al, ; Hagopian & Frank‐Crawford, ).…”

Self-injurious behavior among individuals with intellectual and developmental disabilities

“…SIB itself is a multifaceted, heterogeneous phenomenon varying in its form, frequency and pattern of occurrence, reinforcing function, co-occurrence with other problem behaviors, and resistance to treatment [31]. Classification for the purpose structuring research and informing treatment of SIB ideally involves identify its controlling variables, which likely include organic/somatic factors, psychiatric conditions, psychosocial/ environmental factors, and behavioral history [32][33][34].…”

“…This diagnosis simply describes the behavior, but does not inform treatment selection as there are no approved medications for SIB. Unfortunately, the sole diagnosis describes SIB as a single diagnostic entity, but fails to recognize decades of behavioral research indicting SIB has a variety of types in terms of the operant reinforcing function [43] -which has important implications for both treatment selection and research [31]. The psychiatric diagnoses that are most relevant to clinical care for individuals suffer from SIB, are diagnoses of co-occurring conditions, including mood instability, irritability, hyperactivity, and other dimensions of functioning that can be targeted with medication [44].…”

“…It is imperative that future research on SIB experimentally control for and directly examine the known functional classes of SIB. Future pharmacological studies could systematically explore if the various functional classes of SIB have differential response to specific drug treatment [31]. With recent findings identifying the most severe and treatment resistant type of SIB (Subtype-2 ASIB) that appears largely if wholly under control of biological variables, its analysis should yield scientific benefit, and ultimately the development of more effective treatments.…”

The stability of function of automatically reinforced vocal stereotypy over time

“…These advances in functional assessment for automatically reinforced behavior have substantial treatment implications; they indicate specific interventions are likely to be more successful with particular subtypes of self‐injury (Hagopian & Frank‐Crawford, ; Hagopian, Rooker, & Yenokyan, ). Thus, if a treatment for automatically reinforced behavior begins to fail after previous treatment success, a new FA may be warranted to identify changes in responding, even if the function of the behavior remains unchanged.…”