BEHAVIORAL AND BIOCHEMICAL MECHANISMS OF SELF INJURY

为什么有些人患有精神发育迟滞和/或自闭症 不断地伤害自己，有些人如此严重， 组织损伤和经常永久性疤痕的点， 仍然是一个谜，没有单一的解决方案。 解开这个 神秘的生物医学和行为科学 并为从业者带来了令人深感不安的问题 和受影响个人的家庭成员。 过去 十年来，许多自我伤害行为（SIB）的案例已经被 通过行为干预成功治疗， 沟通和其他功能技能。 实际问题 与长期治疗相关的费用，以及 约1/3的时间出现没有明确社会概况的病例 然而，这表明，关于为什么要这样做， 人们自我伤害。 我们的总体目标是改善治疗， 完善诊断，并澄清不同的机制， 自伤的形式。 考虑到自伤的严重性， 令人惊讶的是，很少有模型更详细地研究了 SIB和 疼痛调节的神经生理学 的主要目标 项目是评估这些变量的有效性， 自我伤害反应的可能预测因素。 治疗将 基于这样的假设，即某些形式的自我伤害涉及 对身体部位的强烈刺激足以引起释放， 内源性阿片肽的受体结合。 因此，委员会认为， 治疗方法包括经皮神经电刺激 （TENS）（阿片激动剂治疗）或纳洛酮（阿片类药物 拮抗剂治疗）。 预测者将包括观测- 自我伤害的环境功能的措施，身体 自伤的部位和强度，以及唾液基线 三种生物活性物质（P物质，甲啡肽， &皮质醇）。 在初步确定受试者（年龄范围 4 - 25）与模具深刻的精神发育迟滞和/或自闭症，我们的 第一个目的是观察和详细描述自我- 伤害发生，它的持续时间和强度是什么，以及在哪里 身体是直接的。 根据这一特征，P物质， 甲硫氨酸脑啡肽和皮质醇将被无创检查 通过唾液作为改变疼痛传递的标记， 治疗反应的预测因子。 筛选和SIB后 分型（即，社会、非社会或混合）37例受试者， 自我伤害主要是非社会性的或混合性的， 为期16周的TENS和阿片拮抗剂纳洛酮治疗 自伤 自我伤害主要是社会原因的受试者 动机将与TENS和阿片拮抗剂进行评估 纳洛酮治疗自伤 自我伤害主要是 社会动机将与TENS进行评估，并获得 通过技术援助服务进行行为干预 交付模式。 三个月和六个月的随访将是 为每一个主题。

Why some people with mental retardation and/or autism repeatedly and persistently injure themselves, some so severely to the point of tissue damage and often times permanent scarring, has remained a mystery eluding a single solution. Unraveling this mystery poses paradoxial biomedical and behavioral science questions and creates deeply troubling problems for practitioners and family members of affected individuals. Over the past decade, many cases of self-injurious behavior (SIB) have been treated successfully using behavioral interventions that teach communication and other functional skills. Practical problems of implementation, costs associated with long-term treatment, and cases with no clear social profile appearing about 1/3 of the time suggest, however, that there is still much to be learned about why people self-injure. Our overall goals are to improve treatment, refine diagnosis, and to clarify mechanisms underlying different forms of self-injury. Given the severity of self-injury, it is surprising that few of the models have examined in more detail the relation between variables common to SIB and the neurophysiology of pain regulation. The main objective of this project is to evaluate the validity of several of these variables as possible predictors of response to self-injury. Treatments will be based on the hypothesis that some forms of self-injury involve intense stimulation of body sites sufficient to elicit the release and receptor binding of endogenous opioid peptides. Accordingly, treatments will include transcutaneous electric nerve stimulation (TENS)(an opioid agonist treatment) or naltrexone (an opioid antagonist treatment). Predictors will include observationally- based measures of the environmental functions of self-injury, body site location and intensity of self-injury, and salivary baseline levels of three bioactive substances (substance P, metenkephalin, & cortisol). Following initial identification of subjects (age range 4-25) with mold to profound mental retardation and/or autism, our first aim is to observe and describe in detail how frequently self- injury occurs, what its duration and intensity is, and where on the body it is directed. Following this characterization, substance P, met-enkephalin, and cortisol will be noninvasively examined through saliva as markers for altered pain transmission and predictors of response to treatment. After screening and SIB subtyping (i.e., social, nonsocial, or mixed) 37 subjects whose self-injury is primarily nonsocial or mixed will be evaluated over a 16-week period with TENS and the opiate antagonist naltrexone for self-injury. Subjects whose self-injury is primarily socially motivated will be evaluated with TENS and the opiate antagonist naltrexone for self-injury. Subjects whose self-injury is primarily socially motivated will be evaluated with TENS and receive behavioral interventions through a technical assistance service delivery model. Three- and six-month follow-ups will be conducted for each subject.