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Autism and Self Injury  
Autism and self injury has very little research. However, in a study on challenging behaviors in individuals with intellectual
disabilities, self injury has been found to be connected to both receptive and expressive communication. Among individuals with
autism, self injurious behavior incidence estimates a range from 20% to 71% depending, relatively, on the IQ and age range of
the child. In young children with autism (4-5 years old), the frequency rate of self injurious behavior may be as high as 52%,
based on parental reports. A number of studies have reported that individuals with autism who are also mentally retarded have
higher levels of self injury than individuals without mental retardation. In children with autism, lower levels of expressive
meaningful language and more severe levels of communication, socialization and daily living skills domains are all associated with
increased self injurious behaviors.

Studies on autism have concluded that self injury in children with autism and individuals with developmental disabilities without
autism to be notably similar. Self injurious behaviors can be seen as a class of behaviors, often highly repetitive and frequent,
that result in physical harm to the individual displaying the behavior. Furthermore, such self injury occurs without an obvious
purpose or intentional self harm. It is important to distinguish between behaviors, such as suicide, that are associated with
deliberate wishes of self harm, and self injurious behavior found in individuals with developmental disabilities, which may occur
in connection with biological causes or are more a result of environmental factors.

Self injury found in autism is also often referred to as self mutilation, self destructive, or masochistic behaviors (gratification
gained from physical pain). Self injurious behaviors are often placed on a category of repetitive stereotypes, and have been
proposed to only differ in severity at the moment of injury. In fact, recent reviews of repetitive behaviors in autism place self
injurious behavior within a wide range. Self injurious behaviors can range from severe, life threatening injuries to less directly
damaging cases.

Some Autistic Self Injurious Behaviors
•        Head rubbing
•        Occasional impact with surface when rocking or head-banging.
•        Finger or arm sucking
•        Frequent arm biting or self-biting
•        Nail picking
•        Mouthing such as putting things in mouth or suck on an object.
•        Bringing up partially digested food and re-chews before swallowing or spitting out.
•        Thigh slapping
•        Poking external openings in the body like eyes, nostrils, mouth, and ears.
•        Stuffing external openings of the body.
•        Hair pulling
•        Self-scratching
•        Self-pinching
•        Ingestion of air
•        Ingestion of feces or playing with feces
•        Excessive fluid intake

For autistic children engaging in self injury the frequency and severity may vary as well as behaviors depending on individual
circumstances and environmental demands. Therefore, a self injurious behavior that may be considered stereotyped may also
appear as self injurious in a different situation. Social self injury in autism seems to occur more often in a social setting, is
directly self aggressive, and associated with stereotyped behaviors and other behavior problems. To date no study has compared
self injury in individuals with autism across the lifespan. Although it’s unpredictable, as the child matures in age certain fixations
depending on adaptive behavior skills, settings, symptoms of severity, and ability level self injurious behaviors may decrease.

Communication Difficulties with Autism and Self Injury

Children with autism may experience self injury because of their communication impairments. It has been proposed that self
injury is a display of an abnormal and impaired need to communicate. Problematic behavior used as unpleasant forms of
communication is developed to replace their lack of socially acceptable forms of verbal and nonverbal communication.
Challenging uncontrolled verbal behavior is minor compared to serious self injuries. Instead of just attempting to decrease the
challenging behavior through direct punishment or prescription treatment, attempts to teach socially appropriate forms of
communication become crucial. Teaching communicative positive ways for escaping punishment can replace the challenging
verbal behaviors used as a substitute for self injurious behaviors.

Autism Self Injury and Causes

Self injury in autism has numerous causes and theories trying to explain it. While most theories are a little more than untested
assumptions, behavioral and neuro-chemical theories have been researched and validated. It is important to mention that attempts
to explain the cause of self injurious behavior in autism has been strongly influenced by the helpful use of treatments.
Determining whether autistic self injury is replacing a form of communication depends on careful analysis of the individual and
consequences of the behavior. As well, the cause and persistence of the injury are seen more as provocation rather than
environmental possibilities.

Autism Self Injury and Self-Stimulation Theory

A trigger to self injury in autism has been proposed as self stimulation theory which seems to occur without apparent
environmental possibilities. In this case self injury is understood as being sustained by self induced stimulation of the senses, and
helps strengthen both sensory and social development. Case studies and neuropsychological models have long supported the
notion that individuals with autism are characterized by a sensory impairment in adjustment, resulting in either under or
oversensitivity to stimulation.

For individuals with autism self-injury is a form of self stimulation corresponds with the idea that repetitive, stereotyped
movements (e.g. body-rocking, hand-flapping, spinning etc.) provide under aroused individuals with stimulation. One study
shows that allowing individuals to replace the stimulating effects of self injury with more suitable behaviors decreases the
problem behaviors. The limited studies suggest that among children with mental retardation, a diagnosis of autism is associated
with a higher incidence of tantrums, aggression, and destruction of property. Most case studies attribute violence to impairment
in theory of mind (a lack of understanding and inability to appreciate the victim’s point of view), although this interpretation is
controversial.

Treatment for Self Injury in Autism

For treatment and education of self injury and autism, applied behavior analysis (ABA) has become widely accepted as an
effective treatment. Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate
behavior and in increasing communication, learning, and appropriate social. ABA therapy created as a behavioral intensive
management of one-on-one child-teacher interaction for 40 hours a week to help reinforce desirable behaviors and reduce
undesirable ones.

Medication for self injurious behaviors in autism has been approved by the U.S. Food and Drug Administration (FDA). The use
of one of the leading prescription antipsychotic medications, Risperdal (risperidone), for the treatment of irritability associated
with autistic disorder, including symptoms of aggression, deliberate self-injury, temper tantrums, and quickly changing moods,
in children and adolescents aged 5 to 16 years. This is the first time the FDA has approved any medication for use in children
and adolescents with autism. The dosage of Risperdal should be individualized for children and adolescents based on weight.
The safety and effectiveness of Risperdal in pediatric patients with autistic disorder less than 5 years of age have not been
established.

For self injury and autism the most effective treatment is most often a combination of medication, cognitive/behavioral therapy,
and other treatment services as needed. Medication is often useful in the management of aggression, and thoughts of self injury.
Behavioral therapy helps individuals control and decreases their injurious behaviors.
Autism and Self Injury  
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