***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Accumulated evidence shows that biology and the environment can mediate self-injurious behavior ( SIB ) in persons with mental retardation . Whether pharmacological treatment alters the environmental mediation of self-injury is unclear . Opioid antagonist effects on sequential dependencies for self-injury were studied in the context of experimental single-subject double-blind placebo-controlled design s. Direct observational data were collected for 4 adult subjects in real time on daily rate of SIB and staff interactions . Clinical ly significant reductions ( i.e. , > or = 33 % ) in SIB rate were observed for 3 of the 4 subjects . For all subjects , the magnitude of the sequential dependency between staff behavior and self-injury was significantly greater during treatment with naltrexone than during treatment with a placebo . Results are discussed in relation to behavioral mechanisms of action regulating medication effects for self-injury The author describes and emphasizes the value of a symptom and behavior rating checklist for teachers ' use in drug studies with children . Factor analysis of the scale produced five factors that gave reliable subscales over a one-month period . A treatment study of dextroamphetamine with a group of children having learning and /or behavior disorders showed significant changes in all factors compared with a placebo group in a double-blind study BACKGROUND It is hypothesized that self-injurious behavior ( SIB ) and symptoms of autism may be due to overactivity in some opioid systems in the brain . We examined the efficacy and safety of naltrexone hydrochloride , an opioid antagonist , in the treatment of SIB and autism in mentally retarded adults . METHOD Thirty-three mentally retarded adults with autism and /or SIB participated in double-blind , placebo-controlled crossover studies . Active treatment was first a single 100-mg dose of naltrexone hydrochloride . Subsequently , 19 subjects were treated with 50 mg/d and 14 with 150 mg/d of naltrexone hydrochloride for 4 weeks . The outcome was assessed by means of direct observations ( n = 11 ) and on the basis of scores on a list of target behaviors , the Aberrant Behavior Checklist , and the Clinical Global Impression Scale . RESULTS Thirty-two subjects ( seven with autism , 16 with autism and SIB , and nine with SIB ) completed the trial . Naltrexone treatment failed to have therapeutic effects on SIB and autism . On the contrary , naltrexone increased the incidence of stereotypic behavior on the Aberrant Behavior Checklist , and the care staff evaluated the effect of the 50-mg/d treatment as being significantly worse than that of the placebo treatment as measured by the Clinical Global Impression Scale . CONCLUSION Our findings suggest that naltrexone has no clinical value for a broad group of mentally retarded subjects with SIB and /or autism The efficacy of the serotonin ( 5-HT ) uptake inhibitor clomipramine in the treatment of self-injurious behavior ( SIB ) was tested in individuals with severe and profound mental retardation . Six of the 8 subjects who completed a double-blind , placebo-controlled crossover trial exhibited a clinical ly significant improvement ( 50 % or greater reduction from placebo ) in the frequency of SIB . Clomipramine treatment was also associated with improvement in SIB intensity , frequency of stereotypy and compulsions , teacher ratings of stereotypy and social withdrawal , and frequency of staff intervention required for problem behaviors . Adverse effects ( seizure and tachycardia/agitation ) occurred in 2 of the 8 subjects . These results represent the first controlled trial of a 5-HT uptake inhibitor in the treatment of SIB in mental retardation BACKGROUND Self-injurious behaviour ( SIB ) is a serious condition , with implication s for the person , their family and financial costs to the state providing care . The previously reported prevalence of SIB has ranged from 1.7 % to 41 % , or 1.7%-23.7 % in community studies . There has been little study of remission rate , and incidence has not previously been reported . SIB has been reported to be individually associated with lower ability , autism and communication impairments , but given the inter-relationships between these three factors , it is not known whether they are independently associated with SIB . This study investigates the point prevalence , incidence and remission rates of SIB among the adult population with intellectual disabilities ( ID ) , and explores which factors are independently associated with SIB . METHOD A prospect i ve cohort study design was used in a general community setting . The participants were all adults ( 16 years and over ) with ID in a defined geographical area .  Individual assessment s were conducted with all participants . RESULTS The point prevalence of SIB ( as defined by DC-LD ) was 4.9 % , the two-year incidence was 0.6 % , and two-year remission rate was 38.2 % . Independently related to SIB were : lower ability level , not living with a family carer , having attention deficit hyperactivity disorder , visual impairment , and not having Down syndrome . Other factors , including communication impairment , autism , and level of deprivation of the area resided within , were not related . CONCLUSIONS SIB is not as enduring and persistent as previously thought ; a significant proportion gains remission in this time period . This should provide hope for families , paid carers and professionals , and reduce therapeutic nihilism . Our study is a first tentative step towards identifying risk-markers for SIB , and developing aetiological hypotheses for subsequent testing . The extent to which SIB may be a relapsing-remitting ( episodic ) condition requires further investigation , so does further hypothesis-based investigation of factors that might be predictive of incidence of , and remission from , SIB This article outlines the initial stages of an ongoing experiment to evaluate the comparative efficacy of two different therapeutic interventions --behaviour modification and gentle teaching -- in the management of challenging  behaviour  in children who have learning disabilities . Using a workshop approach , parents are taught the principles and practice of one of these two interventions to enable better management of their child 's challenging behaviour . A range of intervention outcomes are then compared with those of a control group . Preliminary analysis of data has been conducted on information gathered from those parents ( n = 24 ) who attended the gentle teaching workshop only . The results indicate that brief intervention training in gentle teaching can have a positive impact upon the challenging behaviour of the child That 's it , a book to wait for in this month . Even you have wanted for long time for releasing this book rating scales and assessment instruments for use in pediatric psychopharmacology research ; you may not be able to get in some stress . Should you go around and seek fro the book until you really get it ? Are you sure ? Are you that free ? This condition will force you to always end up to get a book . But now , we are coming to give you excellent solution Several recent reports have indicated that opioid blockers are effective in attenuating  self-injurious behavior ( SIB ) .  In the present study , four patients with SIB were challenged with four fixed doses ( 0 , 25 , 50 , 100 mg ) of naltrexone . In a double-blind procedure , all patients received each dose on a different week as determined by latin square design . Naltrexone was given on Monday and Wednesday of each week , and patients were videotaped daily for 10 minutes in the morning and afternoon . The tapes were scored for incidents of SIB , stereotypy , and activity , with interrater reliability of 0.93 . The Conners Teacher Rating Scale was administered by staff in the morning and afternoon each day . The Vinel and was completed each week ( Thursday ) . All patients had decreased SIB when treated with naltrexone . Three patients decreased their SIB as dose of naltrexone increased . There were no consistent effects of naltrexone on stereotypy , activity , or performance on the Conners or the Vinel and . These results suggest that endogenous opioids are implicated in SIB and that naltrexone is a powerful tool for examination of this treatment-resistant behavior The opioid antagonist naltrexone was administered to 8 adults with severe or profound mental retardation and extensive histories of self-injurious behavior . Five-minute behavioral sample s were observed r and omly out of every hour from 8 a.m. through 3 p.m. , Monday through Friday , for four 2-week phases ( baseline , placebo , 50 mg , and 100 mg ) . During naltrexone administration , there were fewer days with frequent head-banging and self-biting , whereas there were more days on which blows to the head or self-biting were infrequent . Self-injurious participants slept 1.38 hours less per night during baseline , which was unaffected by naltrexone 
    Output:
    
Due to sparse data , an absence of power and statistical significance , and high risk of bias for four of the included trials , we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo