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Headbanging

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children with typical development can show a range of stereotyped and self-injurious behaviour (SIB) e.g. headbanging, head-hitting, self-biting
- meaning of these behaviours in the course of development remains a matter of discussion
  - however, the disappearance of SIB often coincides with the mastery of communication tools, especially language
    - in a survey of SIB in people receiving intellectual disabilities services, it was estimated that 12% of adults in hospitals and 3% of those in the community displayed SIB, while from 3% to 12% of children with intellectual disabilities showed SIB, depending on age (1)
  - SIB has been reported to be associated with poor communication skills
    - association with a wide range of medical condition also suggests the role of neurotransmission disturbances (2)
    - there are several risk factors that increase the probability of developing SIB
      - following factors are associated with increased probability of developing SIB:
        (1) severe or profound developmental disabilities;
        (2) sensory or physical disability; and
        (3) specific genetic disorders and syndromes
      - a meta-analysis of studies conducted over the past 30 years on SIB exhibited by individuals with IDD (3)
        suggested that the three top-risk factors for SIB were
        (1) severe or profound intellectual delay ;
        (2) diagnosis of autism; and
        (3) deficits in receptive or expressive communication
      - a study explored the factors related to the outcome of self-injurious behaviour (SIB) in children with pervasive developmental disorders (PDD) (1):
        speech deficits and autism severity were significant risk factors for a negative outcome
    - behavioural theories also suggest that SIB is related to external (e.g. social pressures, sleep deprivation, changes in environment) and/or internal factors (e.g. emotion, puberty, maturation, ageing, nutritional changes, overall heath) through positive or negative reinforcement
- general agreement among clinicians and scientists that well-established cases of SIB are more difficult to treat than emerging SIB with fewer historical response-reinforcer relations
- functional communication training has proven to be a very effective treatment for well-established cases of SIB maintained by social consequences
  - key issue for FCT is the notion of response covariation, also referred to as response competition or functional equivalence
    - response covariation has been demonstrated when participants are taught to emit a low effort response that produces immediate access to the same reinforcer that maintains SIB
  - later intervention may be slower to produce desired long-term treatment effects, given greater response strength and more resistance to extinction (e.g. greater response-reinforcer relations for SIB)

Reference:

(1) Baghdadli A et al.What Factors are Related to a Negative Outcome of Self-Injurious Behaviour During Childhood in Pervasive Developmental Disorders? JARDI 2008; 21 (2): 142-149.
(2) Richman DM. Annotation: Early intervention and prevention of self-injurious behaviour exhibited by young children with developmental disabilities.JIDR 2008; 52 (1):3-17.
(3) McClintock K et al. Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. JIDR 2003;47: 405-16.

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