2016 Gatlinburg Conference Symposium
SS-10
Symposium Title: Self Injurious Behavior, Proto-Injurious Behavior, and Restricted and Repetitive Behavior in IDD and ASD:
Contingencies, Precursors, and Developmental Context
Chair: Kristen Medeiros
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Overview: This symposium will discuss various behavior problems from three perspectives: contingencies, precursors, and
developmental contexts. The studies utilize a variety of samples and methods to answer questions about behavior problems in
order to assist in developing successful interventions. These findings are useful for clinical researchers, educators, or policy
makers in the field of intellectual and developmental disabilities and Autism.
Paper 1 of 3
Paper Title: "Contagious" Self-Injurious Behavior among Individuals with Intellectual And Developmental Disabilities in
Community Settings
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Authors: Andrea B. Courtemanche , Blair P. Lloyd , Johanna L. Staubitz , Sherry Crossley
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Introduction: Self-injurious behavior (SIB) can be a chronic condition among individuals with intellectual and developmental
disabilities (IDD). SIB may be a learned behavior maintained by environmental consequences (e.g., staff attention) (Carr, 1977).
Using sequential analysis methodology, several studies have documented a sequential dependence between instances of SIB
(i.e., contagious SIB) rather than dependence between SIB and social consequences (e.g., Marion, Touchette, & Sandman, 2003).
That is, rather than SIB resulting in a consistent social consequence, one instance of SIB is likely to be followed by another
instance of SIB. Sequentially-dependent SIB has also been associated with altered patterns of endorphins and other hormones,
suggesting that SIB may be maintained by biological factors rather than environmental (Sandman et al., 2008). Because many of
the participants in these studies lived in institution-like settings, it is unclear whether the absence of social contingencies may
have been due to relatively low rates of social attention in that environment. The purpose of the present study was to use
sequential analysis methodology to assess behavior-behavior (SIB-SIB) and behavior-environment (SIB-staff attention)
contingencies for a group of individuals with IDD living in community settings.
Methods: Seven individuals (ages 15-50) with IDD and chronic SIB were recruited to participate. Individuals were videotaped
during their daily routines at home and in the community. A continuous, timed-event recording system was used to code videos
for the frequency of SIB and the frequency and duration of staff attention and participant engagement in functional activities.
Participant and staff behavior were analyzed for frequency, duration, inter-observer agreement, and sequential dependencies
(i.e., Yule's Q). An event lag with contiguous pause approach (Lloyd, Yoder, Tapp, & Staubitz, in press) was used to analyze
sequential dependencies.
Results: For many participants, a sequential pattern of SIB was identified. Thus, for some of these individuals, SIB was more likely
to be followed by another instance of SIB than by staff attention. The best predictor of SIB was a previous instance of SIB.
Additionally, sequential patterns varied based on idiosyncratic topographies of SIB.
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Central Connecticut State University
University of Saint Joseph
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Vanderbilt University
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2016 Gatlinburg Conference Symposium
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Discussion: The results of the current study suggest that some participants' SIB may be maintained by non-social consequences.
Additionally, these results highlight the possibility that multiple topographies of SIB may serve multiple functions. Future
research should evaluate the relationship between sequential associations of SIB in natural contexts, behavioral function as
determined by a functional analysis and potentially relevant biological factors to better understand the causal mechanisms of
chronic SIB.
References/Citations:
• Lloyd, B. P., Yoder, P. J., Tapp, J., & Staubitz, J. L. (in press). The relative accuracy and interpretability of five sequential
analysis methods: A simulation study. Behavior Research Methods.
• Marion, S., Touchette, P., & Sandman, C. (2003). Sequential analysis reveals a unique structure for self-injurious
behavior. American Journal on Mental Retardation, 108, 301-313.
• Sandman, C., Touchette, P., Marion, S., & Chicz-DeMet, A. (2008). The role of proopiomelanocortin (POMC) in
sequentially dependent self-injurious behavior.Developmental Psychobiology, 50, 680-689.
Paper 2 of 3
Paper Title: Stereotyped Behaviours as Precursors of Self-Injurious Behaviours: A Longitudinal Study with Infants and Toddlers at
Risk for Developmental Delay
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Authors: Johannes Rojahn , Lucy Barnard-Brak , Kristen Medeiros , Stephen Schroeder
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Introduction: The notion that stereotypic behaviours may be functional (Guess & Carr, 1991) and structural (Berkson, Tupa, &
Sherman, 2001) precursors of self-injurious behaviour (SIB) has been considered in the past, but the available empirical evidence
is still inconsistent and ambiguous.
Methods: In a longitudinal study, we collected data on stereotypic behaviour and SIB from 160 infants and toddlers who were atrisk for developmental delay. Interviews were conducted with parents at three time points during a one-year span using the
Behaviour Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001), which contains subscales for SIB and
stereotyped behaviour. We used growth modeling to estimate linear trends in several models. Model fit was evaluated according
to a combination of fit statistics as is recommended in structural equation or latent variable modeling approaches such as latent
growth modeling.
Results: In examining the relationship between stereotyped behaviours and SIB across time, the model that represented earlier
stereotyped behaviour as predicting later SIB fit the data better than the other models.
Discussion: The findings corroborate the notion that stereotyped behaviours can be a precursor of SIB. If replicated by other
studies, it makes a case for considering early intervening with stereotyped behaviour as a SIB prevention strategy.
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George Mason University
Texas Tech University
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University of Kansas
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2016 Gatlinburg Conference Symposium
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References/Citations:
• Berkson, G., Tupa, M., & Sherman, L. (2001). Early development of stereotyped and self-injurious behaviours: I.
incidence. American Journal on Mental Retardation, 106(6), 539-547.
• Guess, D., & Carr, E. (1991). Emergence and maintenance of stereotypy and self-injury. American Journal on Mental
Retardation, 96(3), 266-319.
• Rojahn, J., Matson, J. L., Lott, D., Esbensen, A. J., & Smalls, Y. (2001). The Behaviour Problems Inventory: An instrument
for the assessment of self-injury, stereotyped behaviour and aggression/destruction in individuals with developmental
disabilities. Journal of Autism and Developmental Disorders, 31, 577 - 588.
Paper 3 of 3
Paper Title: Developmental Trajectories of SIB and RRB in Children with Autism
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Authors: Cristan Farmer , Lisa Joseph , Audrey Thurm
Introduction: Differential expression of subtypes of restricted and repetitive behavior (RRB) in autism spectrum disorder (ASD)
across childhood has been documented in both cross-sectional and longitudinal data (Esbensen, Seltzer, Lam, & Bodfish, 2009;
Richler, Huerta, Bishop, & Lord, 2010). Very little is known about the childhood developmental course of self-injurious behavior
(SIB) in ASD, although cross-sectional data suggest that the behaviors are more common in younger children (Baghdadli, Pascal,
Grisi, & Aussilloux, 2003). The elucidation of the developmental trajectories of RRB and SIB, and their relationship over time, may
help to identify subgroups of children with ASD with shared etiology.
Methods: The Repetitive Behavior Scale-Revised (RBS-R; Bodfish, Symons, Parker, & Lewis, 2000; using the Lam & Aman, 2007
structure) was completed up to six times by parents of 106 children aged 2-9 years enrolled in a longitudinal naturalistic study of
DSM-IV-TR autistic disorder. Latent class growth curve modeling was used to characterize developmental trajectories of scores
on the RBS-R, including Stereotyped Behavior, Restricted Interests, Self-Injurious Behavior, Compulsive Behavior, and
Ritualistic/Sameness Behavior. Finally, we plan to estimate joint trajectory models to characterize the developmental
relationships among the constructs.
Results: Baseline latent growth curves were fit to the data from each subscale of the RBS-R. Subscales representing lower-order
behaviors (i.e., SIB, Stereotyped Behavior, and Restricted Behavior) were best represented by intercept-only models, while the
higher-order behavior subscales (i.e., Compulsive Behavior and Ritualistic/Sameness Behaviors) were best represented by
quadratic growth curves. However, chi-square tests of model fit were significant for all models, indicating lack of fit. We
proceeded with latent class mixture model analysis, using the best-fit latent growth curve model as the baseline. Requesting up
to four classes and progressively releasing model constraints, we selected the best-fitting model using several standard measures
of relative and absolute fit. For all subscales, the selected latent class mixture model was significantly better fit to the data than
the latent growth curve. Two-class models best fit the lower-order behaviors: SIB: Low/steady, 94%; low/rising, 6%; Stereotyped:
Low/steady, 73%; low/increasing, 27%; Restricted Interests: low/rising, 81%; high/decreasing, 19%. The remaining subscales
were best fit by three-class models: Compulsive (low/decreasing, 67%; moderate /increasing, 21%; high/decreasing, 12%) and
Ritualistic/Sameness (low/steady, 84%; low/rising, 10%; moderate/increasing, 6%).
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Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health
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Discussion: Non-mixture latent growth curves did not sufficiently describe the development of RBS-R scores between the ages of
2 and 7 years in this sample of children with ASD. Models with two or three classes of varying trajectories better described the
data. We are currently fitting joint-trajectory models, to explore whether the profile of development in RRB is a useful
phenotypic indicator. Finally, we will explore predictors of class membership, such as medical information (e.g., genetic
conditions, prenatal/perinatal complications, other health problems) and behavioral data (e.g., severity of non-RRB ASD
symptoms, cognitive level, adaptive functioning). All of these results, as well as general methodological issues, will be the focus
of discussion.
References/Citations:
• Baghdadli, A., Pascal, C., Grisi, S., & Aussilloux, C. (2003). Risk factors for self‐injurious behaviours among 222 young
children with autistic disorders. Journal of Intellectual Disability Research, 47(8), 622-627.
• Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons
to mental retardation. Journal of autism and developmental disorders, 30(3), 237-243.
• Lam, K. S., & Aman, M. G. (2007). The Repetitive Behavior Scale-Revised: Independent validation in individuals with
autism spectrum disorders. Journal of autism and developmental disorders, 37(5), 855-866.
• Esbensen, A. J., Seltzer, M. M., Lam, K. S., & Bodfish, J. W. (2009). Age-related differences in restricted repetitive
behaviors in autism spectrum disorders. Journal of autism and developmental disorders, 39(1), 57-66.
• Richler, J., Huerta, M., Bishop, S. L., & Lord, C. (2010). Developmental trajectories of restricted and repetitive behaviors
and interests in children with autism spectrum disorders. Development and psychopathology, 22(01), 55-69.
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