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What percentage of the developmentally delayed population exhibits dangerous behaviors?

A 2013 study published in the journal Research in Autism Spectrum Disorders found that over half of autistic kids exhibit aggressive behavior. Obviously, not all these behaviors are severe enough to warrant medical intervention. A 2005 study on dangerous behaviors by British researchers found that 11.5% of their autistic subjects presented with self-injury that qualified as a “marked problem,” as compared to a “minor problem”; the aggression of just over 16% was intense enough to be rated a “marked problem.”

 

Won’t kids outgrow aggressive and self-injurious behaviors?

Doctors and parents commonly report that violence, especially among autistic boys already prone to rages, actually increases during puberty, and studies support this observation.  The 2005 British study referred to above tested developmentally delayed subjects on a wide range of challenging behaviors at two points twelve years apart.  Although many of the behaviors, including sensitivity to sound and rigid adherence to routine, diminished over time, aggression and self-injury increased, with more than twice as many subjects displaying a “marked problem” with aggression as young adults than they did as children.

 

Aren’t dangerous behaviors caused by ineffective parents or teachers? 

Sometimes.  If kids – both on and off the spectrum – get their way by throwing tantrums, they’ll definitely keep doing so.  It’s important to look at the context of behaviors to determine whether they are under operant control (in response to environmental triggers) or intrinsically motivated (provoked by a neurological disturbance).  If a child becomes aggressive or self-injurious in specific circumstances – such as when demands are placed upon him, or desired items are withheld – odds are, the behaviors are under operant control.  If he exhibits aggressive or self-injurious behaviors unpredictably, under any and all circumstances, then it’s likely those behaviors are intrinsically motivated.

 

Can’t aggressive and self-injurious behaviors be controlled with behavior strategies alone?

If a functional analysis reveals that an individual’s dangerous behaviors are under operant control, than a behavior plan is definitely the first step.  However, these behaviors often have complex etiologies.  For example, a child’s aggression might have initially been intrinsically motivated, yet developed an operant component after the child subconsciously learned that his tantrums had positive results – some of which caregivers may not have intended or even been aware of, such as an increase in attention. This is why treatment plans for individuals with the most severe aggression and self-injury generally include both a behavior and a medical piece. 

It should be noted that behavior plans have little chance of working until any neurological impairments are corrected through medication and/or ECT. 

 

Isn’t the EASI Foundation just a thinly veiled pro-ECT propaganda machine?

Actually, our support for ECT isn’t at all veiled.  ECT was the only therapy that resolved our sons’ intractable aggression and self-injury – behaviors so severe they would have necessitated residential placements, sedation and physical restraint.  And we want other parents to know that ECT is an option for children with similar, pharmacologically-resistant behaviors.  But no, that isn’t the sole purpose of the EASI Foundation.  We aim to be a comprehensive resource for families of individuals with dangerous behaviors, a place where parents can find psychiatrists, schools, therapists, camps, equipment and yes, ECT providers, while connecting and sharing information with one another.