Self-injurious behaviors with increased likelihood of injury in autistic youth: The role of distress linked to a strong preference for sameness

Lay Abstract

This study explored factors associated with repetitive self-injurious behaviors in autistic youth, focusing on emotional distress linked to a strong preference for routines (often referred to as insistence on sameness), a category of behaviors that includes difficulties with change and a strong preference for routines and/or rituals. We examined two categories of self-injurious behaviors: lower likelihood of physical injury (self-injurious behavior-Low Likelihood) and higher likelihood of physical injury (self-injurious behavior-High Likelihood). The study included 1892 autistic youth of varying ages and cognitive abilities. The main finding was that distress associated with disruptions to routines was the strongest predictor of all types of self-injurious behavior. Youth with greater sensitivity to sensory input or sensory-seeking behaviors were more likely to engage in self-injurious behaviors that could increase risk of physical injury. In contrast, those with reduced sensitivity to sensory input were less likely to engage in self-injurious behaviors. Demographic factors also played a role in the manifestation and severity of self-injurious behaviors. Lower household income was strongly associated with greater self-injurious behavior severity. In addition, higher speech production (e.g. speaking in full sentences) was associated with greater severity of self-injurious behavior-Low Likelihood and self-injurious behavior-High Likelihood. These findings highlight the complexity of self-injurious behaviors in autistic youth and the importance of understanding the different factors that contribute to these behaviors. This study may help to contribute to the development of more responsive, tailored interventions for self-injurious behaviors among autistic youth.