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

The study was naturalistic, so conditions were not controlled, and differences in staffing, structure, and medication between sites could have influenced observed self-injury rates. Parent reports of home self-injury were based on a 30-day retrospective questionnaire, while hospital data was direct observation, which may have missed low-frequency incidents. Inter-rater reliability for direct care staff recording hospital self-injury was not obtained, potentially affecting the accuracy of the hospital data. Medication or intensive behavioral interventions initiated during admission may have reduced daily self-injury rates in the hospital, confounding the comparison with home behavior. The sample was drawn from specialized psychiatric inpatient units, so findings may not generalize to children with autism in community or outpatient settings.

Dr. Handen received support from the National Institute for Aging, Autism Speaks, Roche, and Eli Lilly. Dr. Mazefsky received support from the National Institute of Child Health and Human Development. Drs. Gabriels, Pedersen, and Wallace reported no conflicts of interest.

Do not assume that a child with reported self-injury at home will display it in the hospital. Nearly two-thirds of children with home self-injury did not exhibit daily self-injury during their inpatient stay, so hospital observation alone may underestimate the problem.