Emergence of SIB in Developmentally Delayed Individuals

描述(由申请人提供)：自伤行为(SIB)在神经发育迟缓和智力落后的个人中出人意料地普遍，原因不明，也没有达成一致的治疗方法。SIB的表达可能会持续到整个生命周期和生命的后期，频率或质量几乎没有变化。已经提出了两种截然不同的SIB模式。一种模式是由可能由环境意外事件维持的短时间比赛组成。第二种模式涉及SIB的持续时间，这可能是由生物因素引起的。我们实验室最近的研究表明，自伤行为本身的近代史对其预测最好(在某些情况下也是如此)。在大多数人中，SIB发作是自我延续的，与先前的情况无关。我们在这一应用中报告，表现出“传染性”(即顺序依赖)模式的SIB的个体也有下丘脑-垂体-肾上腺(HPA)应激轴的失调。我们得出结论，SIB的维持既有生物学上的易感性，也有生物学上的后果。这些结论可能为时过早，有必要对环境背景进行更广泛的评估。此外，目前还没有关于是什么引发了传染性循环的数据。这项建议的目的是研究引发和维持SIB发作的行为、环境和生物环境。30个SIB个体和30个对照受试者，全部居住在一个大型住宅设施中，将在体内和在实验性的行为功能分析(FAB)期间进行观察。它们的行为、相互作用和环境条件将通过计算机辅助程序进行记录。另一天早上将采集血液以测量HPA的活性。具体目标是：(I)使用顺序和时间依赖的时间序列分析，确定在体内和FAB条件下，SIB的模式如何受到环境背景的影响；(Ii)确定在第一次或单独的SIB发作之前，是否存在一致的环境事件模式或行为之间的关系；(Hi)确定HPA应激轴与SIB的启动之间的关系；(Iv)对选定的具有明确的SIB生物(或内部)动机证据的受试者应用和评估合理的药物治疗。本项目的研究结果将有助于理解SIB的产生和维持。

DESCRIPTION (provided by applicant): Self-injuring behavior (SIB) surprisingly prevalent among neurodevelopmentally delayed and mentally retarded individuals, has no known cause and no agreed upon treatment. Expression of SIB may persist throughout the lifespan and into later stages of life, with little change in frequency or quality. Two distinct patterns of SIB have been proposed. One pattern consists of short bouts that may be maintained by environmental contingencies. A second pattern involves protracted periods of SIB that probably is motivated by biological factors. Recent studies from our laboratory indicated that self-injuring behavior was predicted best (and in some cases only) by its own recent history. In a significant majority of individuals, SIB episodes were self-perpetuating and not related to antecedent conditions. We report in this application that individuals exhibiting "contagious" (i.e. sequentially dependent) patterns of SIB also have a disregulated hypothalamic- pituitary-adrenal (HPA) stress axis. We have concluded that there is both a biological predisposition to, and a biological consequence for, the maintenance of SIB. These conclusions may be premature and a more extensive evaluation of the environmental context is warranted. Moreover, there are no data about what initiates a contagious cycle. The purpose of this proposal is to examine the behavioral, environmental and biological circumstances that initiate and maintain SIB episodes. Thirty individuals exhibiting SIB and thirty control subjects, all residing in a large residential facility will be observed in vivo and during an experimental functional analysis of behavior (FAB). Their behavior, interactions and the environmental conditions will be recorded with computer-assisted procedures. Blood will be collected for measures of HPA activity in the morning on a separate day. The Specific Aims are: (i) Determine how the patterns of SIB are affected by environmental context in both in vivo and FAB conditions using sequentially- and temporally-dependent time series analysis, (ii) Determine if there are consistent patterns of environmental events or relations among behaviors that are antecedent to the first or isolated SIB episodes; (Hi) Determine the relation between the HPA stress axis the initiation of SIB, (iv) Apply and evaluate a rational pharmacological treatment to a selected cohort of subjects who present clear evidence of biological (or internal) motivation for SIB. Findings from this project will contribute to the understanding of the emergence and maintenance of SIB.