Journal of Autism and Developmental Disorders

, Volume 48, Issue 11, pp 3678–3688 | Cite as

Risk Factors for Self-injurious Behavior in an Inpatient Psychiatric Sample of Children with Autism Spectrum Disorder: A Naturalistic Observation Study

  • Benjamin L. HandenEmail author
  • Carla A. Mazefsky
  • Robin L. Gabriels
  • Kahsi A. Pedersen
  • Meredith Wallace
  • Matthew Siegel
  • The Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
S.I. : Autism Inpatient Collection - Studying the Severely Affected


Limited information about self-injurious behavior (SIB) is known for children and adolescents with Autism Spectrum Disorder (ASD) who require intensive behavioral health interventions. We examined risk-factors for SIB in 302 individuals with ASD (ages 4–20) admitted to six specialized psychiatric inpatient units. Seventy-four percent were reported by a caregiver to display SIB, however, only 25% were observed to engage in daily SIB during hospitalization. Those exhibiting SIB across environments had significantly higher ratings on caregiver questionnaires of SIB severity. Tree-structured classification was used to develop and validate two predictive models, one indicating which inpatient youth with ASD are likely to have SIB and a second indicating which individuals with SIB at home are likely to continue in an inpatient setting.


Autism Spectrum Disorder (ASD) Autism Inpatient Collection (AIC) Self-injurious behavior (SIB) Psychiatric hospitalization 



The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, MD (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla A. Mazefsky, PhD (Western Psychiatric Institute and Clinic; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L. Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Joanne Dixon, PhD, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeill, BA, Ernest Pedapati, MD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Cathleen Small, PhD, Kahsi A. Pedersen, PhD, Nicole Stuckey, MSN, RN, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated.

Author Contributions

MT, CM, KP and RG conceived of the parent study on which this manuscript is based, collaborated in the coordination of the study and supervised the data collection. BH conceived of the study, participated in its design and drafted the manuscript. MW performed the statistical analysis. All authors read and approved the final manuscript.


This study was funded by the Simons Foundation Autism Research Initiative (SFARI #296318 to M.S.) and the Nancy Lurie Marks Family Foundation.

Compliance with Ethical Standards

Conflict of interest

Dr. Handen received support from the National Institute for Aging (R01AG031110-03A1; 1 R01 AG051406-01), Autism Speaks, Roche and Eli Lilly. Dr. Mazefsky receives support from the National Institute of Child Health and Human Development (R01HD079512; K23HD060601). Drs. Gabriels, Pedersen, Wallace have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Benjamin L. Handen
    • 1
    Email author
  • Carla A. Mazefsky
    • 1
  • Robin L. Gabriels
    • 2
  • Kahsi A. Pedersen
    • 3
  • Meredith Wallace
    • 1
  • Matthew Siegel
    • 3
  • The Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
  1. 1.Department of PsychiatryUniversity of PittsburghPittsburghUSA
  2. 2.Children’s Hospital of ColoradoAuroraUSA
  3. 3.Tufts University School of MedicineSouth PortlandUSA

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