Self Injurious Behaviour (SIB)

SIB refers to a class of behaviors which the individual inflicts upon his/herself that have the potential to result in physical injury, more specifically tissue damage. SIB may manifest in numerous ways, including but not limited to head banging, self-cutting, self-choking, self-biting, self-scratching, hair yanking, and hand mouthing^[1].

In children with Autistic Spectrum Disrder, SIB tends to be classified as “stereotyped SIB” as opposed to the “impulsive SIB” that is habitual in nature as seen in serious psychiatric illness or even in typically developing adolescents and adults.

• Lifetime prevalence of 50% in children with ASD
• The most common forms of SIB in those with ASD are self-biting, self-scratching, skin picking or pinching, self-punching, and head banging; less common but still occurring types of SIB in persons with ASD include eye pressing or gouging, pulling one’s own hair, teeth, or fingernails, dislocation of joints (eg, fingers, periorbital area, mandible), pica, and knee-to-head hitting^[2].
• There is a direct link between problem behaviors and a diagnosis of intellectual disability, with around 25% of individuals with intellectual disability experiencing self-injurious behavior.
• Problem behaviors can sometimes be indicative of coexisting psychiatric disorders in individuals with intellectual disabilities, as well as those with autism spectrum disorders.

Conducting a functional behavior assessment (FBA) can help identify any behavioral factors that may be contributing to the self-injurious behavior (SIB). Additionally, it is important to explore various behavior-based intervention techniques that can be used to reduce SIB.

The behavioural theory of SIB suggests that these behaviors are learned and provide the individual with some form of reinforcement^[1].The reinforcement can come from the individual's environment or from their own body, either externally or internally. At times, SIB can fulfill a social-communicative purpose, leading to alterations in the person's surroundings. For instance, SIB can lead to a decrease in the demands placed on a person, allowing them to obtain something they want or receive attention from others. Therefore, the SIB can persist over time due to positive or negative reinforcement, making it difficult to alter the behaviors without addressing the environmental factors. Identifying the factors that reinforce self-injurious behavior (SIB) in individuals requires conducting appropriate assessments. It is important to understand the unique reinforcement sources that motivate SIB for each person.

Several parent or caregiver administered instruments currently exist which assess for challenging behaviors in the general population and those with developmental disorders.

• Aberrant Behavior Checklist^[3]
• Behavior Problems Inventory-01^[4]
• Children’s Scale of Hostility and Aggression: Reactive/Proactive^[5]
• Developmental Behavior Checklist^[6]
• Nisonger Child Behavior Rating Form^[7]

Exclusively for ASD

• Self-Injury Trauma (SIT) scale^[8]
• PDD Behavior Inventory^[9]
• Autism Spectrum Disorders – Behavior Problems for Children^[10]
• Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)-Part 3^[11]