SELF INJURIOUS BEHAVIOR IN MENTALLY RETARDED INDIVIDUALS: CAUSES AND INTERVENTION STRATEGIES

Yıl 2010, Cilt: 18 Sayı: 3, 731 - 742, 01.09.2010

R. Fırat Şipal

Öz

Self Injurius Behavior SIB in mentally retarded children is a frequent but a not enough studied behavior in special education. When causing harm to himself is assumed, SIB is considered as a frequent severe behavior problem. As in all behavior problems, SIB may be derived from social reinforcements and it may be possible to reduce the frequency of these behaviors by instructional strategies. Besides these strategies, numerous medical treatments take place in reducing SIB. However, these medical treatments have no clear effects and have several side effects blocking the positive effects. As a result, it can be said that, SIB can mostly reduced by instructional strategies. At this point, author of the study suggest that, specialists working with mentally retarded children must be aware of fuctional analysis and be able to apply appropriate behavior modulation methods.

Anahtar Kelimeler

Self Injurious behavior, Behavior Problem, Mental retardation

ZİHİNSEL ENGELLİ BİREYLERDE KENDİNE ZARAR VERME DAVRANIŞI: SEBEPLERİ VE MÜDAHALE YÖNTEMLERİ

Öz

Zihinsel engelli bireylerde Kendine Zarar Verme Davranışı KZVD , birçok durumda sıklıkla karşılaşılan; ancak, araştırmalarda gerektiği kadar yer almayan bir konudur. Bireyin kendisine verdiği zarar göz önüne alındığında KZVD, ileri derecede davranış problemi olarak sıklıkla karşılaşılan bir durum olmaktadır. Bütün davranış problemlerinde olduğu gibi KZVD’de de sosyal ilgi ve buna bağlı pekiştirmeler söz konusudur. Bunun yanı sıra KZVD’nin azaltılmasında etkin olan birçok ilacın varlığı da bilinmektedir. Ancak bu ilaçlar, KZVD’nin azaltılmasında belirgin etkilere sahip değildir. Mevcut ilaçların bir takım yan etkilere sahip olması, olumlu etkileri engeller durumdadır. Sonuç olarak zihinsel engelli bireylerde karşılaşılan KZVD, günümüzde en etkin şekilde davranış değiştirme yöntemleri ile azaltılabilmektedir.

Anahtar Kelimeler

Kendine Zarar Verme Davranışı, Davranış Problemi, Zihinsel Engel

Kaynakça

• 1. Winchel, R.M. ve Stanley, M. (1991). Self-Injurious Behavior: A Review of the Behavior and Biology of The Self-Mutilation. The American Journal of Psychiatry. 148:3, pp306- 317.
• 2. Guess, D., ve Carr, E. G. (1991). Emergence and maintenance of stereotypy and self-injury. American Journal on Mental Retardation, 96, 299–319.
• 3. Murphy, G. H., Hall, S., Oliver, C. ve Kissi-Debra, R. (1999). Identification of early selfinjurious behaviour in young children with intellectual disability. Journal of Intellectual Disability Research, 43, 149–163.
• 4. Emerson, E., Robertson, J., Letchford, S., Fowler, S. ve Jones, M. (1996). The long-term effects of behavioural residential special education on children with severely challenging behaviours: changes in behaviour and skills. Journal of Applied Research in Intellectual Disabilities, 9, 240–255.
• 5. Kiernan, C. C. ve Alborz, A. (1996). Persistence and change in challenging and problem behaviours of young adults with learning disability of young adults living in the family home. Journal of Applied Research in Intellectual Disability, 9, 181–193.
• 6. Murphy, G. H., Oliver, C., Corbett, J., Crayton, L., Hales, J., Head, D. ve Hall, S. (1993). Epidemiology of self-injury, characteristics of people with self injury and initial treatment outcome. In C. Kiernan (Ed.), Research to practice? Implication of research on the challenging behaviour of people with learning disabilities. (pp. 135–188). Clevedon: British Institute of Learning Disabilities.
• 7. Schroeder, S. R., Schroeder, C. S., Smith, B. ve Dalldorf, J. (1978). Prevalence of selfinjurious behavior in a large state facility for the retarded: a three year follow-up. Journal of Autism and Childhood Schizophrenia, 8, 261–269.
• 8. Windahl, S. I. (1988). Self-injurious behavior in a time perspective. Paper to the Eighth Congress of the International Association for the Scientific Study of Mental Deficiency, Dublin.
• 9. Wallace, M.D. ve ark. (1999). Rapid Assessment Of The Effects Of Restraint On SelfInjury and Adaptive Behavior. Journal of Applied Behavior Analysis. 32:4, pp:525-528.
• 10. Lindauer, S.E., Deleon, I.G. ve Fisher, W.W. (1999). Decreasing Signs of Negative Affect and Correlated Self-Injury in an Individual With Mental Retardation and Mood Disturbances. Journal of Applied Behavior Analysis. 32;1, pp103-106
• 11. Worsdell, A.S. ve ark. (2000). Effects of Continuous and Intermittent Reinforcement For Problem Behavior During Functional Communication Training. Journal of Applied Behavior Analysis. v33:2, pp:167-179.
• 12. Wheeler, J.J.ve ark. (2002). Structural Analysis of Instructional Variables and Their Effects on Task-Engagement and Self-Aggression. Education and Training in Mental Retardation and Developmental Disabilities, 37(4), 391-398.
• 13. Carey, Y.A. ve Halle, J.W. (2002). The Effect of an Idiosyncractic Stimulus on SelfInjurious Behavior During Task Demands. Education and Treatment of Children. 25:1, pp:131-141.
• 14. Thompson ve ark. (1999). Effects of Reinforcement For Alternative Behavior During Punishment of Self-Injury. Journal of Applied Behavior Analysis. v33:3, pp:317-328.
• 15. Zhou, L., Gerald, A.G. ve Iwata, B.A. (2000). Effects of Increased Response Effort on Self-Injury and Object Manipulation As Competing Responses. Journal of Applied Behavior Analysis. v33:1, pp:29-40.
• 16. Griffin J. C., Ricketts R. W., Williams D. E., Locke B. J., Altmeyer B. K. ve Stark M. T. (1987). A community survey of self-injurious behavior among developmentally disabled children and adolescents. Hospital and Community Psychiatry 38, 959-63.
• 17. Schroeder, S. R., Kanoy, R. C., Mulick, J. A., Rojahn, J., Thios, S. J., Stevens, M. ve Hawk, B. (1986). Environmental antecedents which affect management and maintenance of programs for self-injurious behavior. In J. H. Hollis & C. E. Meyers (Eds.), Lifethreatening behavior: analysis and intervention. Washington, DC: American Association on Mental Deficiency.
• 18. Iwata B. A., Dorsey M. F., Slifer K. J., Bauman K. E. ve Richman G. S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities 2, 3-20.
• 19. Carr, E. G. ve Durand, V. M. (1985). Reducing behaviour problems through functional communicational training. Journal of Applied Behaviour Analysis, 18, 111-126.
• 20. Iwata, B., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., Rodgers, T. A., Lerman, D. C., Shore, B. A., Mazaleski, J. L., Goh, H-L., Cowdery, G. E., Kalsher, M. J., McCosh, K. C, ve Willis, K. D. (1994). The functions of self-injurious behavior: an experimentalepidemiological study. Journal of Applied Behavior Analysis, 27, 215–240.
• 21. Vollmer T. R. (1995). Progressing from brief assessments to extended experimental analyses in the evaluation of aberrant behavior. Journal of Applied Behavior Analysis 28, 561- 76.
• 22. Erbaş, D., Kırcaali-İftar, G., Tekin-İftar, E. (2004). İşlevsel Değerlendirme. Davranış Sorunlarıyla Başa Çıkma ve Uygun Davranışlar Kazandırma Süreci. Kök Yayıncılık, Ankara.
• 23. Culatta, R.A. ve Tompkins, J.R. (1999); Fundamentals of Special Education. What Every Teacher Needs To Know. Prentice Hall Inc. New Jersey.
• 24. Kaner, S. (2003). Özkel Gereksinimli Çocuklar ve Özel Eğitime Giriş. Ed: Ataman, A. Gündüz Eğitim ve Yayıncılık, Ankara.
• 25. Sarı, H. (2003). Özel Eğitime muhtaç öğrencilerin eğitimleriyle ilgili çağdaş öneriler. Pegem Yayıncılık, Ankara
• 26. Leffert, J.S., Siperstein, G.N. ve Mıllıkan, E.(2000). Understanding social adaptation in children with mental retardation: A social-cognitive perspective. Exceptional Children,v66:i4,p530.
• 27. Reid, J.B., Patterson, G.R. ve Snyder, J. (2002). Antisocial Behavior in children and Adolescents. A Developmental Analysis and Model for Intervention. American Psychological Association, USA.
• 28. Bowe, F.G. (2004). Birth to Eight: Early Childhood Special Education. 3rd. ed. Thomson Learning Publ. USA.
• 29. Symons, F.J., Koppekin, A. ve Wehby, J.H. (1999). Treatment of Self-ınjurious Behavior and Quality of Life for Persons With Mental Retardation. Mental Retardation. 37:4, pp297-307.
• 30. Symons, F.J., Butler, M.G., Sanders, I.D. ve Thompson, T. (1999). Self-Injurious Behavior and Prader-Willi Syndrome: Behavioral forms and Body Locations. American Journal on Mental Retardation 104;3, pp260-269.
• 31. Cohen, S.A. ve ark. (1998). Risperidone for Aggression and Self-Injurious Behavior in Adults with Mental Retardation. Journal of Autism and Developmental Disorders. 28(3), pp229-233.
• 32. Emerson, E., Alborz, A., Reeves, D., Mason, H., Swarbrick, R., Kiernan, C. ve Mason, L. (1997). The HARC Challenging Behaviour Project. Report 2: the prevalence of challenging behaviour. Manchester: Hester Adrian Research Centre, University of Manchester.
• 33. Oliver, C., Murphy, G. H. ve Corbett, J. A. (1987). Self-injurious behaviour in people with mental handicap: a total population survey. Journal of Mental Deficiency Research, 31, 147–162.
• 34. Rojahn, J. (1986). Self-injurious and stereotypic behavior of noninstitutionalized mentally retarded people: prevalence and classification. American Journal of Mental Deficiency, 91, 268–276.
• 35. Borthwick-Duffy, S. A. (1994). Prevalence of destructive behaviors. In T. Thompson & D. B. Gray (Eds.), Destructive behavior in developmental disabilities: diagnosis and treatment (pp. 3–23).
• 36. Nissen, J. M. J. F. ve Haveman, M. J. (1997). Mortality and avoidable death in people with severe self-injurious behaviour: results of a Dutch study. Journal of Intellectual Disability Research, 41, 252–257.
• 37. Kiernan C. ve Kiernan D. (1994) Challenging behaviour in schools for pupils with severe learning difficulties. Mental Handicap Research 7, 177-201.
• 38. Kahng, S.W. ve ark. (2000). Comparison of Single and Multiple Functional Comunication Training Responses for The Treatment of Problem Behavior. Journal of Applied Behavior Analysis. v33:3
• 39. Carr ve ark. (1994). Communication Based Intervention for Problem Behavior: A User’s Guide for Producing Positive Change. Baltimore, Brookes.
• 40. Heward, W.L. (1996). Exceptional Children. An Instruction to Special Education (5th ed.), Merril Publishing Company, USA
• 41. Durand, V. M. (1990). Severe behaviour problems: A functional communication training approach. New York: Guilford.
• 42. Kuder, J.J. (1997). Language and Communication Disabilities. Allyn and Bacon Pub. USA.
• 43. Ruedrich, S., Swales, T. P., Fossaceca, C., Toliver, J. ve Rutkowski, A. (1999). Effect of divalproex sodium on aggression and self-injurious behavior in adults with intellectual disability: A retrospective review. Journal of Intellectual disability Research, 43(2), pp105-111.
• 44. Thompson ve ark. (1994). Opioid antagonist effects on self-injury in adults with mental retardation: Response form and location as determinants of medication effects. American Journal on Mental Retardation, 99, pp85-102.
• 45. Bhatara V. S. ve Carvera J. (1994) Medications for aggressiveness. Journal of the Academy of Child and Adolescent Psychiatry 33, 282.
• 46. Hollander E., Grossman R., Stein D. J. ve Kwon J. (1996). Borderline personality disorder and impulsive aggression: the role for divalproex sodium treatment. Psychiatric Annals 26, S46-48.
• 47. Narayan M. ve Nelson J. C. (1997) Treatment of dementia with behavioral disturbance using divalproex or a combination of divalproex and a neuroleptic. Journal of Clinical Psychiatry 58, 351-4.
• 48. Sandborn W. D., Bendfeldt F. ve Handy R. (1995) Valproic acid for physically aggressive behavior in geriatric patients. American Journal of Geriatric Psychiatry 3, 239- 42.
• 49. Lott A. D., McElroy S. L. ve Keys M. A. (1995) Valproate in the treatment of behavioral agitation in elderly patients with dementia. Journal of Neuropsychiatry and Clinical Neurosciences 7, 314-19.
• 50. Özyürek, M. (2004). Sınıfta Davranış Değiştirme. Uygulamalı Davranış Analizi. Kök Yayıncılık, Ankara.
• 51. Özyürek, M. (2005). Bireysel farklılıkları inceleme yaklaşımları. Kök yayıncılık, Ankara.
• 52. Coleman, M. C. (1992). Behavior disorders. Theory and practice. Simon & Schuster Inc. NY.
• 53. Çakır, S. (2006). Zihinsel engelli öğrencilere doğrudan öğretim yaklaşımıyla sosyal beceri öğretiminin etkililiğinin incelenmesi. Yayınlanmamış yüksek lisans tezi, Gazi Üniversitesi, Ankara.
• 54. Milli Eğitim Bakanlığı (2005). Özel Eğitim Hizmet Yönetmeliği, MEB Yayınevi, Ankara.