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Self-Injurious Behavior
Self-injurious behavior is among the most perplexing and serious forms of psychopathology in children with developmental disabilities. It is defined as the repetitive and deliberate infliction of harm to one's own body (American Psychiatric Association, 1994). Common forms of self-injury include self-biting; selfpunching; and repetitive banging of the head and limbs against solid, unforgiving surfaces such as walls, tables and floors. Less common forms of self-injury include repeatedly dislocating and relocating joints; eye gouging; pulling out one's own hair, teeth, or fingernails; pica, and self-mutilation of the genitals and rectum. Self-injurious behavior affects 8% to 14% of the child population with autism and/or mental retardation. The vast majority of these children are nonverbal with IQs below 50. Fortunately, most children with self-injurious behavior respond favorably to treatment. Behavior therapy using positive reinforcement, medication, and various combinations of behavior therapy and medication are frequently reported as successful in virtually eliminating the problem. However, there remains a significant minority of children with special needs who are unresponsive to treatment. Self-injury in this refractory group is at high risk of escalating to lifethreatening proportions and results in the affected children being consigned to the use of highly restrictive protective equipment such as helmets, padded mitts, arm and leg restraints, and other individually tailored articles of protective clothing.
Motivational and Biological Hypotheses of Self-Injury
The mechanisms by which self-injurious behavior is developed and maintained are not well understood.
For the most part, children who engage in self-injury are a heterogeneous and ill-defined group. That is to say, the reasons underlying why one child engages in self-injury may be entirely different from why another child engages in self-injury, even if the self-injurious behavior of the two children in question takes the same form. In this regard, researchers (Baumeister & Rollings, 1976; Winchel & Stanley, 1991) have delineated a number of motivational and biological hypotheses fundamental to children with special needs who engage in self-injurious behavior. Importantly, none of the proposed hypotheses discussed below are viewed as excluding each other. The likelihood of one hypothesis overlapping with one or more of the other hypotheses is highly probable and, in fact, is to be expected.
Positive Reinforcement
Self-injurious behavior is learned and maintained through operant conditioning using a positive reinforcement paradigm. Children may engage in selfinjury because it gains them access to something that they prefer such as social attention (usually in the form of a comforting behavior), which is delivered to them contingent upon performance of the self-injurious act. Self-injury is a dramatic event that often leads to the use of physical management techniques by parents and teachers as a means of protecting the child from harm. Favell and colleagues (1978) caution that some children with special needs may find physical management to be rewarding (i.e., the equivalent of social attention), which may result in a paradoxical effect of increasing the frequency of the self-injurious behavior that it was designed to stop.
Negative Reinforcement
Self-injurious behavior is learned and maintained through operant conditioning using a negative reinforcement paradigm. Children may engage in selfinjury because it allows them to terminate or escape from a condition that they find to be aversive, such as a physical exercise routine, contingent upon performance of the self-injurious behavior. Self-injury is an event that draws immediate attention and concern from adults. Parents, teachers, and other caretakers, acting in good faith, may modify or suspend limits or demands on a child because it has the effect of stopping the self-injury, at least for the time being. Unfortunately, it also teaches the child that self-injury is an effective way to communicate protest and to escape from nonpreferred tasks. In the long run, it has the effect of worsening the child's self-injury problem.
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