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A 10-year-old female with relapsing gross haematuria and Münchausen syndrome is reported, emphasizing the rarity of this situation in children and the difficult diagnostic pathway. A careful personality study of the patient and family members is absolutely necessary in order to proceed with diagnosis and successful treatment.
This study investigated the social context of self-injurious behavior in autistic, schizophrenic, and mentally retarded children residing in a state hospital. Social interactions between subjects and staff were recorded along with subjects' self-destructive behavior. The results showed a substantial increase in self-destructive behavior following the staff's presentation of demands, denials, and punishments in 19 of the 20 subjects. These results are consistent with the hypothesis that self-injurious behavior is a social behavior, which is determined by persons in the environment. In addition, the self-destructive behavior of one subject may have been largely self-stimulatory in nature.
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This study attemped to isolate some of the stimulus variables that controlled the self-destructive behavior of a psychotic child. In Experiment 1, the child was exposed to several demand and nondemand situations. In Experiment 2, the situation containing demands was modified so that demands now occurred in the context of a positive, ongoing interaction between the child and the adult therapist. The rates of self-destructive behavior underwent several orderly changes: (1) Rates were high in demand situations and low in nondemand and modifieddemand situations; (2) rates decreased sharply when a stimulus correlated with the termination of demands was introduced; and (3) rates of self-destruction typically showed gradual increases within each of those sessions which contained only demands. These results were interpreted as suggesting that (1) self-destruction, under certain circumstances, may be conceptualized as an escape response which is negatively reinforced by the termination of a demand situation and (2) certain modifications of the social environment may provide discriminative stimuli for behaviors other than self-destruction, thereby decreasing this behavior.
One hundred and twenty-eight mentally retarded children, ages 6 to 14, from a special school were assessed by teachers in terms of nine maladaptive behaviors. The results indicated that the prevalence of some maladaptive behaviors changed as a function of IQ and age, and that there were splits of such changes as IQ-dependent and as age-dependent by maladaptive behavior.
Parents of 85 blind children aged from 10 months to the 6th year of life were asked regarding the frequency, duration and typical situations of the occurrence of various stereotypic behaviors in their children. The Bielefeld Parents' Questionnaire for Blind and Sighted Infants and Preschoolers was used as the instrument of measurement. All of the children displayed at least one stereotypic behavior; most displayed several stereotypic behaviors according to the parents' reports. Eye poking and body rocking dominated within the prevalence hierarchy. Four typical situations could be identified in which stereotypic behaviors were shown: monotony, arousal, demand, and during feeding or eating. The results suggested that repetitive hand and finger movements, stereotypic manipulation of objects, and making a face(s) mainly occur within arousal situations whereas eye poking, whimpering, and sucking thumbs or fingers especially are linked to monotony.
The authors report on six cases of chronic iron deficiency anemia in which a diagnosis of factitious anemia was made. Erythrokinetic studies demonstrated iron deficiency and blood loss. Besides these features, two kinetic abnormalities are described: precocious splenic sequestration of red cells and excess hemolysis. This hemolytic syndrome seems to be correlated to the duration of anemia rather than to its severity.
Emergency visits of borderline and chronically self-destructive patients remains a frequent and difficult problem. The author relates examples and clinical observations from these visits with emphasis on the meanings of suicide attempts, observations of families, patterns of visits, and psychodynamic issues. Suggestions for an approach to these patients are offered. The approach aims to preserve viable psychotherapeutic relationships through repeated crises and to decrease long-term risks of suicide. Theoretical consideration of the emergency room as an available object is suggested.
Violence to self and to others on a locked, acute-care unit is reported for a three-year period. Drug abuse correlated strongly with both types of violence. Self-violence appeared to be a more predictable event due to its diagnostic specificity, history of prior violence and timing of the episodes. Assaults occurred more randomly demonstrating only a mild association with schizophrenia, but not with other psychotic disorders.
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The effects of haloperidol and a mild punishment on the severe self-injurious behavior and several collateral behaviors of a 17-year-old profoundly retarded male were assessed. A 12-month analysis using a withdrawal design suggested that neither the medication nor the behavioral intervention alone was effective in significantly reducing the frequency of self-injurious behavior. When combined, however, these interventions produced dramatic reductions in the subject's self-injurious behavior. The haloperidol may have acted as a "setting event" for the successful use of the punishment. Suppression of this behavior was maintained at 6 months and 1 year following the end of the analysis. The collateral behaviors were differentially affected by the behavioral and pharmacological interventions. Time spent in bed and the appearance of drooling increased with the introduction of the haloperidol, while percent correct on a fine-motor task increased only when the interventions were applied simultaneously. The results point out the importance of a careful behavioral analysis for both pharmacological and behavioral interventions and their possible combined actions.
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Self-injury is a severe behavioral problem commonly observed in institutionalized mentally retarded individuals. While several forms of therapy are available, pharmacological treatment is most often used in institutions to control this behavior. This paper evaluated the clinical and experimental literature on the effects of pharmacotherapy for self-injury. Few general conclusions could be drawn mainly due to the small number of studies and the general lack of methodological rigor of these studies. However, there was some indication that antipsychotics and antimanics may prove to be useful in the treatment of self-injury and warrant further investigation. Several areas of future research were discussed.
This study examined (a) how parents of autistic children, parents of other handicapped children, and parents of nonhandicapped children rate, as a whole, acceptability of time-out, differential reinforcement, overcorrection, and shock as treatments for self-injurious behavior, and (b) whether these parents show differences, as groups, in ratings of these treatments. On the Treatment Evaluation Inventory, all groups consistently rated differential reinforcement, time-out, and overcorrection as acceptable and shock as unacceptable. Differential reinforcement was consistently rated as the most acceptable, but the groups differed in ratings of acceptability of other treatments. On the Semantic Differential, ratings of differential reinforcement, overcorrection, and time-out did not differ. However, shock was consistently rated as the most potent and active of treatments as well as the most unacceptable. The implications of these findings for treatment of autistic and other handicapped children are discussed.
Flexible arm splints permit the control of hand-to-mouth contacts without restricting range of motion. In the present study they effectively suppressed the self-injurious finger biting of a child with Lesch-Nyhan disease and a profoundly retarded client's stereotypic finger sucking. They appear to offer an easily applied and much less restrictive alternative to the soft-tie and tubular arm restraints in common use.
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Explore the source record for details and available documents.