The Relationship of ASD Symptoms with the Occurrence of Self-Injury Behaviors Among Middle School Students

Background:  Autism spectrum disorder (ASD) is a neurodevelopmental disorder involving significant phenotypic variability, and is characterized by social and communication deficits in addition to restricted and repetitive behaviors (American Psychiatric Association, 2000). Children with ASD often exhibit comorbidity with behavioral problems as well as psychiatric symptoms (e.g. Lecavalier, 2006). One of the most serious problems is self-injury behavior (SIB). It has been reported that up to 52% of ASD children show more than one type of SIB (Poustka & Lisch, 1993). Because SIB is a risk factor for increased suicidal ideation and probability of suicidal attempts (Glenn & Klonsky, 2009), it is crucial to provide appropriate, sufficient supports with children and adolescents with ASD. It is not specific to children and adolescents with ASD, but it is common among school-aged children (Camelot Foundation & Mental Health Foundation, 2006). However, there are few studies to investigate the relationship between ASD symptoms and SIB among school aged children. We have little known about whether ASD symptoms have any effects on the occurrence of SIB.

Objectives:  The present study examined the effects of ASD symptoms on the occurrence of SIB among students from seventh through ninth grades in Japan.

Methods:  The participants were students (N =2,181) attending all junior high schools in a city, along with their parents. The students completed a questionnaire to assess the occurrence of two types of SIB, hitting and cutting. Their parents answered the Autism Spectrum Screening Questionnaire (Ehlers, Gillberg, & Wing, 1999) and the Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale-IV (Du Paul et al., 1998), to assess the ASD and ADHD symptoms that the students exhibited. Multivariate logistic regression analysis was performed to study the effect of ASD symptoms on SIB over and above the effects of age, grades, and ADHD symptoms

Results:  Multivariate logistic regression analysis indicated that after controlling for age, grade, and ADHD symptoms, ASD symptoms had an effect on the occurrence of both types of SIB that we assessed. Specifically, students with more severe ASD symptoms were more likely to engage in both hitting and cutting SBI (hitting SIB: OR = 1.404, p < .001; cutting SIB: OR = 1.371, p =.001). Age and ADHD symptoms also had a significant influence on the occurrence of SIB. Female students were more likely to engage in both types of SIB, and students with severe ADHD symptoms had a higher probability of the hitting SBI.

Conclusions: The current study indicated that even after controlling for sex, grade, and the severity of ADHD symptoms, ASD symptoms had a significantly influence on the occurrence of SIB, which suggests that ASD symptoms are a risk factor for SBI. In addition to the result of the current study, previous studies have reported that children and adolescents with ASD show higher levels of depression, which increases the probability of SIB (e.g., Kim et al., 2000). Therefore, we should provide children and adolescents with ASD, even those who have not official diagnosis, with sufficient psychosocial support to prevent them from engaging in SIB.