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Large study shows self-injury common among children with autism

by  /  4 January 2017
Injury-prone: Children whose mothers lack a college degree are at heightened risk of self-harm.

Kris Seraphin / Millennium Images, UK

About one in four children with autism hit, scratch or otherwise hurt themselves, suggests an analysis of school and medical records for more than 8,000 children in the United States. Children who engage in self-injury tend to have mood and behavioral challenges, as well as cognitive impairment.

The findings, from two related studies, document the prevalence of self-injury among children with autism in a large, diverse population1,2. Previous studies were small, and often limited to individuals with autism who also have serious behavioral problems.

“Self-injurious behavior is not something that is rare in children with autism,” says Gnakub Norbert Soke, who led both studies at the University of Colorado in Aurora.

The results underscore the urgency of better understanding and developing treatments for self-injury, which can lead to hospitalization or even death, Soke says. The findings appeared in November in the Journal of Autism and Developmental Disorders.

Knowing which conditions and problems accompany self-injury could help parents and doctors identify children with autism at risk for the behavior. “We need to watch for signs,” says Jill Fodstad, assistant professor of clinical psychology at Indiana University in Indianapolis. “It would be worth it to try to intervene at the first signs of self-injury, or even before it begins.” Fodstad was not involved in either study.

World of difference:

Soke’s team analyzed data from 8,065 children aged 8 who are part of the Autism and Developmental Disabilities Monitoring Network, a program funded by by the U.S. Centers for Disease Control and Prevention. In this network, clinicians review school and medical records for signs of autism to determine the prevalence of the condition.

Soke and his colleagues looked for signs of self-injury in records from six sites for the years 2000, 2006 and 2008. These were the most recent years for which self-injury information was complete. The behaviors included self-inflicted banging of the head, poking the eyes, hair-pulling, biting, hitting and pinching. Their search revealed that 2,234 (28 percent) of the children with autism harm themselves.

The findings suggest that parents and doctors should be alert for signs of self-injury in children with autism.

“People who are working with individuals with autism should have their radar up for that,” says Lee Wachtel, medical director of the Neurobehavioral Unit at the Kennedy Krieger Institute in Baltimore, who was not involved in the work. “When what’s driving the self-injury is identified, particularly at a young age, and appropriate treatments are implemented, you can make a world of difference in terms of the child’s global functioning.”

Elevated risk:

In a second study, Soke and his colleagues investigated possible connections between self-injurious behaviors and a variety of other features — from a child’s sex and race to sleep problems and sensory sensitivities. The researchers also took note of family characteristics, such as age of parents, maternal education, insurance coverage and income.

In addition to the school and medical records, the researchers included data for 5,102 children in the Autism Treatment Network, a national registry of children with confirmed autism diagnoses.

The team found an association between self-injury and a dozen other behaviors and traits, including aggression, anxiety, hyperactivity and mood and sleep problems. These features might represent risk factors for self-injury, Soke says.

Children of women who lack a college degree, rely on public health insurance or live in low-income areas also have an elevated risk of self-injury, the team reported. These factors may raise the risk of self-injury by limiting a family’s access to treatments for conditions that underlie self-harm, Soke says.

The researchers did not see any links between self-harm and sex, race, ethnicity, digestive problems or parental age. Scientists should follow children with autism over time to determine when self-injurious behaviors emerge and to identify early warning signs, Soke says.

  1. Soke G.N. et al. J. Autism Dev. Disord. 46, 3607-3614 (2016) PubMed
  2. Soke G.N. et al. J. Autism Dev. Disord. Epub ahead of print (2016) PubMed

7 responses to “Large study shows self-injury common among children with autism”

  1. Dena says:

    You may want to update this to look at NSSIB (non-suicidal self injurious behavior) in autistic adults. Google scholar. Plenty of articles.

  2. Katie Wright says:

    It is so sad that despite tens of million in federal “treatment” research funds the ATN has yet to fund even ONE study on treatment for SIBs. Families know SIBs are often related to GI pain. ATN has yet to fund one GI treatment study. It is so tragic that the hospital based ATNs has failed to provide any medical treatment innovation. The “SIBs are common” studies confirming what we know to be true are nice but the ASD community needs solutions. ATN should be studying medical hemp or THC for example, Right now the only major option is ECT which is should be an absolute last resort. These young ASD adults are so vulnerable and in such pain, treatment of SIBs should have been a top ATN priority since its inception 10 years ago.

  3. Jill Escher says:

    Terrific article on an urgent topic. My nonverbal son self-harms but the triggers appear to be varied–anxiety, emotional upset, boredom, physical pain, protest, and more. It really depends on the day–sometimes there’s an addressable underlying cause, other times there’s not. Supplements that ease his anxiety help immensely (albeit n=1). Many parents of kids who self-harm have experimented with medical cannabis to beneficial effect, at least according to anecdotal reports–hopefully research will catch up (many of these parents are absolutely desperate it should be noted).

    • shannonrosa says:

      Regarding marijuana — yes, we need more research. And not just because of SIBs, although that is important too. I recently spoke with journalist Maia Szalavitz, who specializes in evidence-based approaches to regulating and researching pharmaceuticals, and she had this to say about the absurd roadblocks to researching the potential benefits of marijuana, including for autistic people (excerpt from a loooong interview):

      “It’s an infinitely safer drug, compared to something like a benzodiazepene, or an anti-depressant. But the point is that people should be able to have access to the things that work for them. And the reason our drug laws are the way they are is because of racism and colonialism — full stop. It has absolutely nothing to do with the relative dangers of drugs. And once we understand that, we should be opening the door to doing research on things like marijuana, like psychedelics, and other things that could benefit people on the Spectrum in a variety of ways. So I’ll be very interested to see how MDMA research in autism goes. But these trials are very slow to be done because of intense regulations, and that’s ridiculous. I actually retweeted Bernie Sanders the other day, because he was saying that marijuana should not be in the same category as heroin in our legal system. My comment was that we shouldn’t even have that category, Schedule 1, because the whole idea of putting something in a category that says “this has no medical use” without doing any research first is inherently nonsensical. Yet that’s exactly what we do, all the time.”

  4. shannonrosa says:

    One crucial SIB trigger that seems to be missing: illness or other medical conditions. As UCSF’s Dr. Clarissa Kripke recently noted, “If you’re supporting someone who has a challenging behavior or meltdowns, and you just guessed that it had to do with their health, you would be right 75% of the time. You should always think about medical causes first. Think about them before you think about other reasons for behaviors.”

    More details, solutions, and examples are in Dr. Clarissa Kripke’s Understanding Autism, Aggression, and Self-Injury: Medical Approaches and Best Support Practices:

  5. Planet Autism says:

    You’ve missed another major one, dermatillomania. Skin picking.

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