Communication training, drug therapy combination greatly reduces or eliminates disorder

NASHVILLE, Tenn. - People who routinely injure themselves may do so in order to stimulate a release of feel-good chemicals in the brain, and most of those sufferers can now be helped with an innovative combination of two therapies, according to Travis Thompson, director of Vanderbilt University's John F. Kennedy Center for Research on Human Development.

Thompson is scheduled to present his findings on self-injury as the keynote speaker at the prestigious British Intellectual and Learning Disabilities (BILD) Conference in London Sept. 14.

Thompson and his colleagues have concluded that many of the estimated 50,000 to 300,000 Americans with developmental disabilities who injure themselves with acts such as head banging and self-biting do so either as a primitive form of communication or to stimulate the release of beta endorphins (the brain's natural "morphine") in the brain. Thompson's latest research indicates that sufferers can be helped dramatically by combining communication training with a regimen of the drug naltrexone, which blocks the brain's opiate receptors.

"This particular combination of therapies works because many people with severe disabilities self-injure either as a means of communicating basic needs or wants or because doing so releases beta endorphin," said Thompson, a professor of psychology, special education and psychiatry at Vanderbilt. "If you can provide an alternative form of communication that they understand, they will do that instead of self-injuring. And by combining two treatments - augmentative communication training and naltrexone - it appears we can greatly reduce or stop self-injury in most cases."

Naltrexone works by blocking the brain's opiate receptors, Thompson explained, so that when beta endorphin is released following self-injury it us unable to bind to the receptors and create the same sensation that occurs, for example, when a heroin addict takes a low dose of heroin.

Thompson and his colleagues have also discovered the locations on the body where people self-injure is indicative of whether naltrexone will reduce self-injury. People who self-injure in acupuncture analgesia sites, such as the temple or the wrist immediately behind the thumb, seem to respond to naltrexone treatment, presumably because self-injury in those sites causes the release of beta endorphin while self-injury in other locations does not. Observing over time where on the body an individual self-injures could help determine which treatment methods are likely to be most effective, Thompson said.

Self-injury is most prevalent in people with severe to profound mental retardation and those with autism, although it also occurs in individuals with other conditions such as Fragile X syndrome, Prader-Willi syndrome and Pervasive Developmental Disorders. Although people who self-injure account for only 3 percent to 17 percent of all those with developmental disabilities, the services they receive account for as much as 20 percent of total service costs, or some $4.5 billion per year.

Historically, people with intractable self-injury were institutionalized and often put in physical restraints. Beginning in the 1960s, neuroleptic medications came into use but because of serious side effects, their use has been greatly decreased. Today, newer neuroleptics are used, as well as antidepressants, but with limited evidence of effectiveness.

In the 1980s, researchers discovered that some self-injury among nonverbal individuals was a primitive attempt at communication. With the teaching of sign language or other means of nonverbal communication, self-injury often decreased. However, a third to a half of people with chronic self-injury did not respond to this treatment.

Thompson has been working on his theories of self-injury, one of the most baffling mysteries of developmental disabilities, since 1987 when he published the first case report of a young adult with intractable self-injury whose treatment with naltrexone virtually stopped the behavior.

The BILD conference is the largest annual conference devoted to intellectual and other developmental disabilities in Britain, and is attended by researchers, physicians, educators and parents of individuals with intellectual disabilities. Thompson's keynote address is titled "Communicative and Pharmacological Interventions for Self-Injury."

More news about the Kennedy Center, a national research center on developmental disabilities, can be found on the center's Web site at www.vanderbilt.edu/kennedy . Facts about Vanderbilt can be found on the Media Relations homepage at http://www.vanderbilt.edu/News . Additional information about Peabody College is at http://www.peabody.vanderbilt.edu/peabody .