Emergence of SIB in Developmentally Delayed Individuals

自伤行为(SIB)在神经发育迟缓和精神发育迟缓人群中的普遍程度令人惊讶 智障患者，没有已知的原因，也没有商定的治疗方法。SIB的表达可能持续存在 在整个生命周期和生命的后期阶段，频率或质量几乎没有变化。两个截然不同的 已经提出了SIB的模式。一种模式由短回合组成，这些回合可以由 环境意外情况。第二种模式涉及SIB的持续时间，这可能是出于动机 是生物因素造成的。我们实验室最近的研究表明，自残行为是可以预测的 最好的(仅在某些情况下)是它自己的近代史。在绝大多数人中，SIB发作 都是自我延续的，与之前的条件无关。我们在这份申请中报告说，个人 表现出“传染性”(即顺序依赖)模式的SIB也具有不受调节的下丘脑- 垂体-肾上腺(HPA)应激轴。我们得出的结论是，既有生物学上的易感性，也有 这是维持SIB的生物学后果。这些结论可能还为时过早，而且 有必要对环境背景进行广泛的评估。此外，没有关于什么的数据 引发了一种传染性的循环。本提案的目的是检查行为、环境和 启动和维持SIB发作的生物学环境。展出SIB的30个人和30个人 对照受试者，所有居住在大型住宅设施中的人将在活体和实验期间进行观察 行为功能分析(FAB)。它们的行为、相互作用和环境条件将是 使用计算机辅助程序进行记录。将采集血液以测量HPA在 另一天的早晨。具体目标是：(I)确定如何影响SIB的模式 使用顺序和时间依赖的时间在体内和FAB条件下的环境背景 系列分析，(2)确定环境事件或环境事件之间的关系是否有一致的模式 在第一次或单独的SIB发作之前的行为；(Hi)确定 HPA应激轴启动SIB，(Iv)应用和评价合理的药物治疗 有明确的生物学(或内部)动机证据的受试者队列。发现 这将有助于对SIB的产生和维护的理解。

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.