Delineating Subtypes of Self-Injurious Behavior Maintained by Automatic Reinforce

自我伤害行为（SIB）是智障人士经历的最严重的问题之一。SIB评估的护理标准包括进行“功能分析”。“这种评估程序涉及在几种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，SIB是由照顾者的反应（例如，照顾者的注意）。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感官刺激等未指明的过程产生强化。术语自动增强（或“自动SIB”）已被用于描述这种无定形和高度耐处理类型的SIB。与大量的研究证明了识别SIB的社会亚型的临床和启发式价值相反，很少有努力针对 描述了自动SIB的亚型。我们提出了三个亚型的自动SIB的基础上观察到的功能分析和治疗的背景下，不同的临床特征。 我们假设这些临床特征反映了与SIB产生的强化（和厌恶）后果相关的不同潜在因素。该模型还通过对SIB生物学基础的研究，包括改变疼痛敏感性。对于一种亚型，SIB的发生率随着环境中刺激水平的变化而降低（亚型I）。对于这一组，我们认为SIB产生的感觉刺激是适度强化的，因为它可以很容易地被其他强化来源（例如，玩具）。然而，对于其他个体，SIB是高度持久的，并且无论环境刺激水平如何都会发生（亚型II）。我们建议，对于这一组，SIB产生更高的生物强化的后果。最后，一些患有自动SIB的人也会进行自我约束，这是一种不相容的行为，并积极防止SIB（亚型III）的发生。我们认为，对于这些个体，SIB也会产生厌恶（例如，潜在的痛苦）的后果，这负面地加强了自我约束，因为它防止了SIB。对39例自动SIB患者的初步临床数据进行分析，为该模型提供了初步支持。所提出的模型为亚型特异性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的内部过程，但我们将进行分析，以帮助我们了解这些临床上不同的亚型的基础。我们将采用一系列的评估技术和措施，以研究如何加强（或厌恶）SIB是在60个人的行为。目前的提案代表了自动SIB亚型的初步步骤-这将为未来的研究奠定基础，旨在了解每个亚型的生物学基础，并为临床试验评估更有针对性的行为和药理学干预措施。

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.