Characteristics of children with autism and unspecified intellectual developmental disorder (intellectual disability) presenting with severe self-injurious behaviours

Abstract

Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB.

Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors.

Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention.

Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder.

Keywords:

• self-injurious behaviour
• autism
• psychiatric comorbidities
• unspecified intellectual developmental disorder
• intellectual disability

Acknowledgements

We would like to acknowledge the following clinicians in the self-injurious behaviours’ clinic for their contributions: Robin Friedlander, Psychiatrist; Anamaria Richardson, Pediatrician; Katie Allen, Behavioural Analyst; Osman Ipsiroglu, Sleep Medicine; Suzanne Lewis, Genetics; Tim Oberlander, Complex Pain; Mary Glasgow-Brown, Occupational Therapist; Vinni Panikkar, Speech and Language Pathologist; Krista McFee, Psychologist.

Consent to participate and publish

Informed consent was obtained from legal guardians. Legal guardians have verbally consented to the submission of case vignettes to the journal.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

The research ethics proposal was submitted for approval to the Research Ethics Board at the University of British Columbia through the UBC Rise system. Ethics approval number H20-02033. Permission has been granted to access the medical and clinical records from British Columbia Children’s Hospital archives.

Additional information

Funding

No funding was received to assist with the preparation of this manuscript.