Delineating Subtypes of Self-Injurious Behavior Maintained by Automatic Reinforce

描述(申请人提供)：自伤行为(SIB)是智障人士经历的最严重的问题之一。对SIB的评估标准包括进行“功能分析”。这个评估程序包括在几个模拟条件下观察个体，以确定SIB持续发生的情况。在大多数情况下，功能分析表明，照顾者的反应(例如，照顾者的关注)加强了SIB。在大约25%的情况下，SIB水平不受社会后果的影响--这表明行为本身通过未指明的过程产生强化，例如感觉刺激。术语“自动增强”(或“自动SiB”)被用来描述这种无定形且高度耐处理的SiB类型。与大量的研究表明识别SIB的社会亚型的临床和启发式价值相比，很少有人针对 描述自动SIB的子类型。根据在功能分析和治疗过程中观察到的不同临床特征，我们提出了自动SIB的三种亚型。 我们假设这些临床特征反映了与SIB产生的强化(和厌恶)后果相关的不同的潜在因素。该模型还基于对SIB生物学基础的研究，包括改变疼痛敏感性。对于一个亚型，SIB的比率作为环境刺激水平的函数而下降(亚型I)。对于这一群体，我们假设SIB产生的感觉刺激是适度强化的，因为它很容易被其他强化来源(如玩具)所克服。然而，对于其他个体，SIB是高度持久的，无论环境刺激的水平如何(亚型II)都会发生。我们认为，对于这一群体，SIB产生了更强的生物强化效应。最后，一些患有自律性SIB的人也会进行自我约束，这是一种不相容的行为，可以积极地防止SIB(亚型III)的发生。我们认为，对于这些人来说，SIB也会产生令人厌恶的(例如，潜在的痛苦)后果，这会负面地加强自我约束，因为它会阻止SIB。对39例自动SIB飞行员的临床资料进行了分析，为该模型提供了初步支持。所提出的模型为亚型特定和可检验的假说提供了概念基础。虽然我们不能直接观察自动SIB的内在过程，但我们将进行分析，帮助我们了解这些临床上不同的亚型可能存在的原因。我们将使用一系列评估技术和措施来检查60名有这种行为的个体的SIB强化(或厌恶)程度。目前的提议是对自动SIB进行亚型划分的第一步，这将为未来旨在了解每一亚型的生物学基础的研究以及评估更有针对性的行为和药物干预的临床试验奠定基础。

DESCRIPTION (provided by applicant): Self-injurious behavior (SIB) is one of the most serious problems experienced by individuals with intellectual disabilities. The standard of care for the assessment of SIB involves conducting a "functional analysis." This assessment procedure involves observing the individual under several analog conditions to identify the situations in which SIB occurs consistently. In most cases, functional analysis indicates that SIB is reinforced by caregiver reactions (e.g., caregiver attention). In roughly 25% of cases, SIB levels are unaffected by social consequences - suggesting that the behavior itself produces reinforcement through unspecified processes such as sensory stimulation. The term automatic reinforcement (or "automatic SIB") has been used to describe this amorphous and highly treatment-resistant type of SIB. In contrast to the vast body of research demonstrating the clinical and heuristic value of identifying social subtypes of SIB, little effort has been aimed at delineating subtypes of automatic SIB. We propose three subtypes of automatic SIB based on distinct clinical features observed during the functional analysis and in the context of treatment. We hypothesize these clinical features reflect distinct underlying factors related to the reinforcing (and aversive) consequences produced by SIB. The model is also informed by research on the biological basis of SIB, including altered pain sensitivity. For one subtype, the rates of SIB decrease as a function of the level of stimulation in the environment (Subtype I). For this group we posit that SIB produces sensory stimulation that is moderately reinforcing in that it can be readily overcome by other sources of reinforcement (e.g., toys). For other individuals, however, SIB is highly persistent and occurs irrespective of the level of environmental stimulation (Subtype II). We propose that for this group, SIB produces more highly potent biologically reinforcing consequences. Finally, some individuals with automatic SIB also engage in self-restraint, a behavior that is incompatible and actively prevents the occurrence of SIB (Subtype III). We propose that for these individuals, SIB also produces aversive (e.g., potentially painful) consequences, which negatively reinforces self-restraint because it prevents SIB. Analysis of pilot clinical data obtained from 39 cases with automatic SIB provides some preliminary support for the model. The proposed model provides the conceptual basis for subtype- specific and testable hypotheses. Although we cannot directly observe internal processes underlying automatic SIB, we will perform analyses that can help us understand what may underlie these clinically distinct subtypes. We will employ a range of assessment techniques and measures to examine how reinforcing (or aversive) SIB is in 60 individuals with the behavior. The current proposal represents an initial step of subtyping automatic SIB - one that will set the stage for future research aimed at understanding the biological underpinnings of each subtype, and for clinical trials evaluating more targeted behavioral and pharmacological interventions.