Emergence of SIB in Developmentally Delayed Individuals

描述（由申请人提供）：自我伤害行为（SIB）令人惊讶地普遍存在于神经发育迟缓和智力迟钝的个体中，没有已知的原因，也没有商定的治疗方法。SIB的表达可以在整个生命周期中持续存在，并进入生命的后期阶段，频率或质量几乎没有变化。已经提出了两种不同的SIB模式。一种模式是由环境突发事件可能维持的短期发作组成。第二种模式涉及长时间的SIB，这可能是由生物因素引起的。我们实验室最近的研究表明，自我伤害行为最好（在某些情况下）由其最近的历史预测。在一个显着的大多数人，SIB事件是自我延续，不相关的先决条件。在本申请中，我们报道了表现出SIB的"传染性"（即顺序依赖性）模式的个体也具有失调的下丘脑-垂体-肾上腺（HPA）应激轴。我们得出的结论是，有一个生物易感性，和生物后果，SIB的维护。这些结论可能为时过早，需要对环境背景进行更广泛的评估。此外，还没有数据表明是什么引发了传染性循环。本建议的目的是检查启动和维持SIB发作的行为，环境和生物环境。将在体内和行为的实验性功能分析（FAB）期间观察30名表现出SIB的个体和30名对照受试者，所有人都居住在大型住宅设施中。他们的行为，相互作用和环境条件将被记录与计算机辅助程序。将在另一天的早晨采集血液用于测量HPA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SIB的模式在体内和FAB条件下如何受到环境背景的影响，（ii）确定在第一次或孤立的SIB发作之前的行为之间是否存在环境事件或关系的一致模式;（iii）确定HPA应力轴与SIB起始之间的关系，（iv）对呈现SIB的生物学（或内部）动机的明确证据的所选受试者群组应用和评估合理的药理学治疗。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.