John Hoch

Self-Injury among a Community Cohort of Young Children at Risk for Intellectual and Developmental Disabilities

OBJECTIVE To identify risk factors for self-injurious behavior in young children with developmental delay and to determine whether that group is also more likely to exhibit other challenging behaviors. STUDY DESIGN A retrospective chart review of 196 children < 6 years of age referred for comprehensive neurodevelopmental evaluations. We analyzed child developmental level, receptive and expressive communication level, mobility, visual and auditory impairment, and co-morbid diagnoses of cerebral palsy, seizure disorders, and autism. RESULTS Sixty-three children (32%; mean age = 42.7 mo, 63% male) were reported to engage in self-injurious behavior at the time of the evaluation. Children with and without self-injurious behavior did not differ on overall developmental level, expressive or receptive language level, mobility status or sensory functioning, or in rates of identification with cerebral palsy, seizure disorders, or autism. However, the self-injurious behavior group was rated significantly higher by parents on destructive behavior, hurting others, and unusual habits. CONCLUSIONS Although self-injurious behavior was reported to occur in 32% of the cohort, the modal frequency was monthly/weekly and the severity was low. No significant differences were found for risk markers reported for adults, adolescents, and older children with intellectual and developmental disabilities. However, self-injurious behavior was comorbid with other behavior problems in this sample.

CALCULATING CONTINGENCIES IN NATURAL ENVIRONMENTS: ISSUES IN THE APPLICATION OF SEQUENTIAL ANALYSIS

Analysis and interpretation of behavior-environment relations are increasingly being conducted with data that have been derived descriptively. This paper provides an overview of the logic that underlies a sequential analytic approach to the analysis of descriptive data. Several methods for quantifying sequential relations are reviewed along with their strengths and weaknesses. Data from descriptive analyses are used to illustrate key points. Issues germane to contingency analysis in natural environments are discussed briefly. It is concluded that the conceptual distinctions among contiguity, contingency, and dependency are critical if the logic of sequential analysis is to be extended successfully to a behavior-analytic account of reinforcement in natural environments.

A Direct Comparison of Self-Injurious and Stereotyped Motor Behavior Between Preschool-Aged Children With and Without Developmental Delays

OBJECTIVE To compare the prevalence of self-injurious behavior (SIB) and stereotyped motor behavior (STY) of preschool-aged children with developmental delays (DD group) and their peers without developmental delays (TD group) using a standardized caregiver report scale. METHODS The Repetitive Behavior Scale-Revised was completed by caregivers of children with developmental delays and their peers without developmental delays. Frequency of occurrence and severity ratings for SIB and STY were compared between groups. RESULTS SIB and STY were reported more often and at a greater level of severity in the DD group. Older chronological age was associated with more severe STY in the DD group but not the TD group. Gender was not related to STY or SIB for either group. CONCLUSIONS Differences in STY and SIB were evident between preschoolers with and without DD. Findings are discussed from developmental and behavioral psychology perspectives regarding the expression of repetitive behavior in developmentally at-risk pediatric populations.

The effects of methylphenidate on the classroom behavior of elementary school-age children with cerebral palsy: A preliminary observational analysis

High- and low-dose methylphenidate administration was evaluated prospectively for 3 elementary school—age children with cerebral palsy, cognitive impairments, and attention-deficit hyperactivity disorder (ADHD) symptoms using single-case, randomized, double-blind, placebo-controlled designs. An observational time sampling protocol was used to directly measure and quantify classroom behavior. Summary level analysis showed that (1) low-dose (0.3 mg/kg/dose) administration was associated with clinically significant (>50%) reductions in stereotyped and disruptive behavior relative to baseline and placebo conditions, (2) high-dose (0.5 mg/kg/dose) administration was associated with exacerbated amounts of stereotyped and disruptive behavior, and (3) no changes were directly observed for task-related behavior at either dose. Results are discussed with respect to previous research with methylphenidate administration and cerebral palsy, and the suggestion is made that further work using larger, randomly selected study samples with complementary measures of behavior and performance appears warranted.

Infrared Thermal Analysis and Individual Differences in Skin Temperature Asymmetry in Rett Syndrome

PURPOSE We evaluated the feasibility of using a portable infrared thermal camera to quantify the degree of thermal dysregulation (cold hands/feet) and test for naturally occurring within-patient skin temperature asymmetry in Rett syndrome. PROCEDURES Infrared thermal images were acquired passively from 15 patients (mean age = 13.7 years, range 4-47) with clinical diagnoses of Rett. Images were acquired using a FLIR T400 infrared thermal camera (still images recorded at 5 Hz, resolution of 320 × 240 pixels, thermal sensitivity = 0.05 °C; capture session lasted approximately 3 minutes). The infrared thermal camera was orthogonal to the body part (hands, feet) and positioned approximately 1 meter from the skins surface. RESULTS There were large intraindividual left/right differences in temperature. Seven (47%) and eight (53%) patients had statistically significant (P <0.05) left/right asymmetries between hands (mean difference = 0.87 °C, standard deviation = 1.21) and feet (mean difference = 1.73 °C, standard deviation = 3.03), respectively. Coders were reliable (intraclass correlations 0.97-0.99) on temperatures and selection of anatomical regions of interest. CONCLUSIONS The degree of thermal asymmetry may reflect prolonged activity of the sympathetic nervous system and individual differences in sympathetic regulation. As clinical trials emerge and endpoints are considered, portable infrared thermal camera may provide one noninvasive means of evaluating changes in sympathetic regulation.

Sequential Analysis of Autonomic Arousal and Self-Injurious Behavior

There have been limited direct tests of the hypothesis that self-injurious behavior (SIB) regulates arousal. In this study, two autonomic biomarkers for physiological arousal (heart rate [HR] and the high-frequency [HF] component of heart rate variability [HRV]) were investigated in relation to SIB for 3 participants with intellectual disabilities. Second-by-second correlations were examined using time series statistical models. The probabilities of HR changes preceding or following SIB were derived using sequential analyses and compared using resampling procedures. Significant correlations and sequential dependencies were found between SIB and arousal parameters. Combining within-subject statistical methods with single-subject experimental designs may provide a replicable methodology for use across larger samples to examine relationships between SIB and arousal in real-world settings.

A Case-controlled Investigation of Pain Experience and Sensory Function in Neuronal Ceroid Lipofuscinosis

Objectives:This case-control study explored pain experience and expression among individuals with neuronal ceroid lipofuscinosis (NCL) through parental report, tactile sensory testing, and infrared thermography (IRT). Materials and Methods:Participants with NCL (n=8; M=14.8 y) and their unaffected siblings (n=8; M=23.5 y) were characterized in terms of pain response to a brief tactile sensory test (light touch, Von Frey monofilament). During sensory testing, behavioral expression was measured using the Battens Observational Pain Scale and infrared thermography (IRT) was used to quantify changes in skin/eye temperature. Results:Children with NCL experienced pain frequently and from multiple sources that negatively impacted their lives. Children with NCL were reactive to the sensory testing as indexed by significant increased IRT temperature change (P<0.001). Across combined sensory conditions, individuals with NCL were significantly more reactive (Battens Observational Pain Scale total score) to sensory testing compared with siblings (P<0.05). Similarly, IRT difference scores between sensory conditions revealed a significant increase in temperature for individuals with NCL compared with siblings (P<0.001). Discussion:Ongoing reported pain was a problem for the children with NCL in this sample. Increased pain expression during the repeated Von Frey filament suggests that the pathophysiology of the ongoing pain may be centrally mediated.