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ROBIN FRIEDLANDER
• Clinical Head, Neuropsychiatry Clinic, BC Children’s
Hospital
• Director, Developmental Disorders Program, UBC Department of
Psychiatry
• Clinical Professor, UBC Department of Psychiatry•
Psychiatrist, Developmental Disability Mental Health
Services, Vancouver Coastal Health & Fraser Health
2
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KATIE ALLEN
Masters in Applied Behaviour AnalysisNortheastern University,
Boston, MA
BCBA since 2005Trained at the New England Centre for Children
(NECC)Vancouver 2006 Present (ABLE Developmental Clinic)Focus on
severe behaviourResidential, home, school, community
3
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MICHELLE SCHMIDT
• PhD Psychology• Director of Instruction, School District No.
36, Surrey• Surrey School District ABA Advisory Committee• Online
Mental Health and Autism Project Advisory Committee (ACT)•
Inter-ministerial initiatives geared toward meeting the needs of
children
and youth who have complex needs• Inclusive Education
4
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5
LEARNING OBJECTIVES1. Describe the presentation and nature of
severe SIB among the ID/
ASD population2. Distinguish the multifactorial drivers of
severe SIB in the population3. Employ treatment options and future
needs for these children and
youth4. Recognize the role of the school district in ensuring
behavioral
interventions are evidence based, and consistent across
community settings
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DISCLOSURE
• We have received no funding nor any non-monetary incentives
from any pharmaceutical companies.
• There is no conflict of interest.
6
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AGENDA
7
1. Nature/presentation, Prevalence, Consequences, & Course2.
Causes3. Case Profile—Medical/Psychiatric Perspective4. Applied
Behaviour Analysis...Functional assessments, analyses, &
treatment5. Case Profiles—Behaviour Analysis perspective6. Role of
the Educational System & Community Partners
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NATURE OF SIB
SELF-INJURIOUS BEHAVIOURS IN INDIVIDUALS WITH AUTISM AND
SEVERE INTELLECTUAL DISABILITIES
8
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• Self-injurious behaviour (SIB) displayed by individuals with
autism and intellectual disabilities, involves the occurrence of
behaviour that results in physical injury to one's own body.
• Most common forms include: head-hitting, head-banging and
hand-biting.
9
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MILD VERSUS SEVERE SIB
MILD Occasional SIB , usually one or 2 bites to the hand or hits
to the head.Clear precipitating environmental or physical cause and
stops fairly quickly.SEVEREDiverse, often highly repetitive and
rhythmic behavior.• Frequency may be 100s of times a day.• results
in physical injury / tissue damage (in the most severe cases, can
result in
retinal detachment, blindness).
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PREVALENCE OF SIB IN AUTISM
• Community Survey: SIB in those with Autism occurs in 28% of
8-year old children (Soke, et al. 2016)
• 3000 children in BC (Dr. Robin Friedlander) exhibit some form
of SIB• No good figures for prevalence of severe SIB in Autism
11
https://link.springer.com/article/10.1007/s10803-016-2879-1https://link.springer.com/article/10.1007/s10803-016-2879-1
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PREVALENCE OF SEVERE SIB• Prevalence of the most severe SIB in
children with moderate to
profound ID is approximately 5% (Oliver et al, 2017)• Children 0
to 19 in BC: 950,370• Prevalence of IQ < 50 = 4 to5 per 1000
children (0.45%) = 4,277
children. • If 5% of such children have the most severe form of
SIB, then the
estimated number of children in BC with the most severe forms of
SIB is 214.
12
https://www.researchgate.net/publication/311964200_Self-injurious_behaviour_in_people_with_intellectual_disability_and_autism_spectrum_disorder
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CONSEQUENCES OF SEVERE SIBS• Physical injury to
self/others• Increased likelihood of
residential care• Excessive use of
medication & restraint• High level of caregiver
Stress• Social isolation
• 30 years ago, the National Institute of Health (NIH) Consensus
estimated costs associated with SIB among individuals with
neurodevelopmental disorders exceeded $3 billion (1989)
13
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COURSE OF SIB• 50% of those with severe SIB start
prior to age 3 and up to 90% before age 10 years of age
(Huisman, 2018).
• Rate of persistence of SIB is 58% (Davies, 2016).
• SIB progresses into adolescence with a corresponding increase
in prevalence and persistence well into adulthood.
14
https://www.sciencedirect.com/science/article/pii/S0149763416303372?via%3Dihubhttp://pure-oai.bham.ac.uk/ws/files/27171542/Davies_Oliver_2016_Self_injury_aggression_and_destruction_in_SID_RDD.pdf
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STEREOTYPIC MOTOR BEHAVIOUR ( SMB)
In typically developing infants, there is a predictable sequence
of rhythmic motor development, which appears stereotypic and
declines by 24 months of age (Thelen, 1979).
Children with severe ID engage in relatively high rates of SIB
compared withtypically developing infants and toddlers (Berkson et
al., 2001).
16
https://www.ncbi.nlm.nih.gov/pubmed/556122https://www.researchgate.net/publication/11646039_Early_Development_of_Stereotyped_and_Self-Injurious_Behaviors_I_Incidence
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DEVELOPMENT AND MAINTENANCE OF SIB
Rhythmic repetitive behaviour Sensitivity to internal states
(e.g. pain, mood);
sensitivity to environment (e.g. noise, gaze)
Social reinforcement
Chris Oliver, (2015).
17
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MULTI-FACTORIAL ETIOLOGY
SIB
Learned Behaviour
Environmental
Biological•Autism•Genetic Syndromes•Internal
discomfort/pain•Over arousal
/emotional dysregulation
•Neuro-psychiatric/• chemical
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MEDICAL/BIOLOGICAL FACTORS
1. Autism with Severe Intellectual Disability2. Genetic
syndromes3. Internal discomfort/pain4. Over arousal/emotional
dysregulation5. Neuropsychiatric
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Genetic Syndromes with Increased Risk of SIB
• Lesch – Nyhan• Cornelia de Lange• Smith Magenis
• Prader Willi• Fragile X
21
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052966/https://www.ncbi.nlm.nih.gov/pubmed/19522788https://www.ncbi.nlm.nih.gov/pubmed/11246713http://europepmc.org/articles/PMC5257292/https://www.ncbi.nlm.nih.gov/pubmed/20946000
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INTERNAL DISCOMFORT/PAIN
• Otitis media ( self-injury to head)• Gastroesophageal Reflux
Disease (SIB around meal
times)• Menses (related to menstrual cycle)• Constipation
22
https://www.tandfonline.com/doi/abs/10.1300/J019v27n02_05https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272540/https://www.jaacap.org/article/S0890-8567(09)61572-0/pdfhttp://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.820.736&rep=rep1&type=pdf
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NEUROPSYCHIATRIC FACTORS• Sleep• Mood• Affective dysregulation•
Compulsions• Tics• Catatonia
23
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CASE STUDIES
24
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CASE CM: PROFILE
• 8 year old boy, with Autism Spectrum Disorder
• Minimal verbal abilities• Lives with parents and younger
brother• Has always been hyperactive
• Performs rituals when passing through doors
• Pain insensitivity• Easily frustrated• Screams, yells, bites
and kicks when
upset (for past 2 or 3 years)
25
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• SIB started at age 4• When calm, bangs head on soft
surfaces; when angry seeks out hard edges to bang head on
• Bites hand and hits chin with hand• Holes in walls• Bangs back
of head against wall
• Boxes eye• Frequency: 100 times/day• Also screams and frequent
temper
outbursts and aggression• Inadequate behavioral assessment
& intervention
26
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27
DX & TREATMENT COURSE• Failed trials of Fluoxetine,
Methylphenidate and Dexedrine• Risperidone 2mg daily. Helped
aggression & SIB, but
weight gain ++ and gynecomastia
• Family moved to Kamloops and enrolled in a special school with
behavioral, OT, SLP, and other support
• Child has practically stopped screaming• 70% reduction in
physical aggression• Hitting self < 5 times a day• Attending
school full time and loves it
OUTCOME
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CASE K: PROFILE• 16 year-old male with severe ID, ASD• SIB since
age of 2, but worse for 8
months• Cycles of severe SIB ( 100’s of times
/day) alternate with weeks when SIB almost absent
• Red, angry bruises over cheeks
• Cycles associated with decreased need for sleep, agitation,
more disruptive at school, irritability, crying or laughing for no
apparent reason, more whooping noises, decreased appetite,
decreased concentration
• Referred by ER after severe episode of SIB with tissue damage
to eye and ear
28
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DX & TREATMENT COURSE• Diagnosis of Bipolar Mood Disorder.•
RX with Olanzepine 5mg/daily.
• Mood cycling settles• SIB brief, only 2 or 3 times a week;
always a reason (e.g., wants space).
OUTCOME
29
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30
MANAGEMENT1. Rule out & treat pain, illness (may need GA,
dental work)2. Treat psychiatric comorbidity3. Functional analysis
of the behavior and behavioral treatment4. Support for family
including respite5. Intensive services for most severe cases (may
require a day treatment
program)6. EARLY IDENTIFICATION AND INTERVENTION
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OUTLINE
• Social importance• Function based treatment• Functional
assessments• Functional analysis review• Advancements in functional
analysis• Case Studies
32
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LITERATURE ON FUNCTION-BASED TREATMENT
“Results from a number of studies have demonstrated that
interventions based on the identification of behavioral function
are more likely to be effective than those that are arbitrarily
chosen.”
Kahng, S.W., & Iwata, B.A. (1999). Correspondence between
outcomes of brief and extended functional analyses. Journal of
Applied Behavior Analysis 32, 149-159.
33
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1284174/
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APPLIED BEHAVIOUR ANALYSIS• Applied• Behaviour• Analytic•
Technological• Conceptually systematic• Effective• Generality
• ABA uses these principles to address challenging problems such
as the reduction self-injury and the acquisition of functional
alternative skills to improve quality of life
34
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OPERANT CONDITIONING
• B.F. Skinner • Operant : Any behaviour whose probability of
occurrence is determined by
it’s history of consequences• Consequences
• Reinforcement (probability increases)• Punishment (probability
decreases)
35
https://en.wikipedia.org/wiki/B._F._Skinner
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THREE TERM CONTINGENCY
A B C
Antecedent ConsequenceBehaviour
36
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RELATION TO FUNCTION
A B C
•Relationship across time
•Repeated presentations
•Function of behaviour = maintaining variable = reinforcer
= Function of Behaviour
37
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LITERATURE ON FUNCTION OF BEHAVIOUR
• Once we have defined a behaviour and we know what it looks
like, the next step is to determine the function of the behaviour
for this particular individual.
• Four main functions.• Even though two children may exhibit the
same exact
behaviour, it could serve two completely different functions for
each individual.
Repp, A.C., & Horner, R. H. (1999). Functional analysis of
problem behavior: From effective assessment to effective support.
London: Wadsworth Publishing Company.
38
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BEHAVIOURAL FUNCTION
1. Attention (positive or negative)•“Don’t do that you’ll hurt
yourself”• “I’m so proud you tied your shoes!”
2. Escape from demands •Academic work, situations,
procedures
3. Access to tangible• Food, toys, a preferred way of
playing
4. Automatic reinforcement
39
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ASSESSMENT FOR FUNCTION• Time and again, practitioners have
reported that the most
difficult aspect of intervening to reduce problem behaviour is
in the assessment or analytic component.
• It is incumbent upon researchers and practitioners to identify
these purposes, because failing to do so results in blind
application of technology, applications that are often ineffective,
short lived in their effects, and usually not replicable by
others
Repp, A.C., & Horner, R. H. (1999). Functional analysis of
problem behavior: From effective assessment to effective support.
London: Wadsworth Publishing Company.
40
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FUNCTIONAL ASSESSMENTS
• Indirect• Survey• Questionnaire
• Direct• DescriptiveABC data sheets
• Functional Analysis
41
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Functional Analysis:• Systematic manipulation of antecedents
and
consequences which place the client in certain situations in an
alternating treatments design to determine whether problem
behaviour occurs consistently in those situations and not in others
(CAUSAL).
Repp, A.C., & Horner, R. H. (1999). Functional analysis of
problem behavior: From effective assessment to effective support.
London: Wadsworth Publishing Company.
42
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Functional Assessment:• Interview and direct observation are
non-experimental in
nature. Observations are conducted in natural environment under
natural circumstances (CORRELATIONAL)
“Interview and direct observation are collectively referred to
in the literature as functional assessment rather than functional
analysis to highlight the fact that only the latter term involves
systematic manipulation of the environment.”
Repp, A.C., & Horner, R. H. (1999). Functional analysis of
problem behavior: From effective assessment to effective support.
London: Wadsworth Publishing Company.
43
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FUNCTIONAL ANALYSIS VS. ASSESSMENT• Although generally
recognized as a superior assessment,
functional analysis procedures have been characterized as
complex, time consuming, and cumbersome.
• As a result, less accurate and less reliable assessment
procedures have been used (descriptive assessment and structured
interviews).
Cooper, L.J., Wacker, D.P., Sasso, G.M., Reimers, T.M., &
Donn, L.K. (1990). Using parents as therapists to evaluate
appropriate behavior of their children: application to a tertiary
diagnostic clinic. Journal of Applied Behavior Analysis 23,
285-296.
44
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ANALOGUE FUNCTIONAL ANALYSISToward a functional analysis of
self-injury• Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman,
K.E., &
Richman, G. S. (1994). Toward a functional analysis of
self-injury. Journal of Applied Behavior Analysis, 27, 197–209.
(Reprinted from Analysis and Intervention in Developmental
Disabilities, 2,).
• Cited by 235 publications indexed in PsycINFO • An additional
533 publications that cite its 1994 reprint.
J.L. Matson (ed.), Functional Assessment for Challenging
Behaviors, 3Autism and Child Psychopathology Series, DOI
10.1007/978-1-4614-3037-7_2, © Springer Science+Business Media, LLC
2012
45
https://www.springer.com/us/book/9781461430360https://www.springer.com/us/book/9781461430360
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FUNCTIONAL ANALYSIS IN RESEARCH
• 435 FA Studies including 981 FAs, since 1961• 26 different
journals• 11 behaviour categories
Special Issue: Special Issue on Functional Analysis:
Commemorating Thirty Years of Research and Practice, 46 (1), pp.
1–21, Spring 2013.
46
https://onlinelibrary.wiley.com/toc/19383703/46/1
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FA IN RESEARCH
47
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Conditions Materials Present Antecedent ManipulationConsequent
Manipulation Tested Function
Attention Moderately preferred toys
Teacher removes attention
Teacher delivers verbal and physical
attention for 15s
Access to social attention
Demand Moderately difficult work
materials
Presentation of work materials and
prompting to complete them
Teacher removes work demands and materials for 15s
Escape from demands
Alone/Ignore None Child is placed in room alone or
ignored with no materials
No consequence to behaviour
Automatic
Tangible Preferred tangible items
2 min. free access before session, then removal of
tangible
Teacher provides access to tangible
item for 15s
Access to tangible
Play Moderately preferred toys
Child has access to toys and teacher delivers attention
every 15s
No consequence Control
48
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0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
25 26 27 28 29 30 31 32 33 34 35
Freq
uenc
y
Sessions
Functional AnalysisAggression
Attention
play
Demand
49
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FUNCTION OF BEHAVIOUR
The same principles of applied behaviour analysis may be
translated into different procedures based on differences in
behavioural function.
Iwata, B.A., Pace, G.M., Cowdery, G.E., & Miltenberger, R.G.
(1994). What makes extinction work: An analysis of procedural from
and function. Journal of Applied Behavior Analysis 27, 131-144.
50
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297782/
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COMMON BEHAVIOUR CHANGE
• E X T I N C T I O N• F U N C T I O N A L C O M M U N I C AT I
O N T R A I N I N G • D I F F E R E N T I A L R E I N F O R C E M E
N T• B L O C K / R E D I R E C T I O N• P O S I T I V E P U N I S H
M E N T
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LITERATURE ONFUNCTION-BASED TREATMENT
“A reasonable conclusion based on descriptions of behavior,
procedure, and outcome reported in the above studies is that
extinction designed for SIB serving one function may have little or
no therapeutic effect on SIB serving a different function.”
Iwata, B.A., Pace, G.M., Cowdery, G.E., & Miltenberger, R.G.
(1994). What makes extinction work: An analysis of procedural from
and function. Journal of Applied Behavior Analysis 27, 131-144.
52
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297782/
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EXTINCTION Extinction is a procedure used to decrease a
behaviour.Definition: when a behaviour that was previously
reinforced no longer receives reinforcement.
Function Treatment Procedure
Attention Extinction Removal of or denied attention
Escape Extinction Continued presentation of demand or aversive
event
Tangible Extinction Denied access to tangible
Automatic Extinction Preventative blocking of sensory
stimulation
53
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FUNCTIONAL COMMUNICATION TRAINING AND DIFFERENTIAL
REINFORCEMENT
• Differentially reinforce alternative response• Place
maladaptive behaviour on extinction• Necessary to determine
function to allocate an appropriate alternative and consequence
Function Treatment ProcedureAttention FCT “Am I doing a good
job?”, “Wow look at me!”
Escape FCT “I need a break” , “I need help.”Tangible FCT “I want
a pretzel”, “I want to earn my puzzle”
Automatic FCT “I need my special toy”, “Can you hold my hands”,
“I need alone time please.”
54
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FUNCTIONAL ANALYSIS: A NECESSITY
Functional analysis will always remain the primary tool that
researchers have for demonstrating causal relationships. To make
compelling demonstrations concerning cause-effect relationships,
particularly in novel relationships, there is simply no known
substitute for functional analysis.
Repp, A.C., & Horner, R. H. (1999). Functional analysis of
problem behavior: From effective assessment to effective support.
London: Wadsworth Publishing Company.
55
https://www.amazon.ca/Functional-Analysis-Problem-Behavior-Assessment/dp/0534348505
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PROFILE
• 10 years old• Lived in residential ABA teaching home for past
three years• Autism diagnosis• Self-injurious behaviour Head
directed Body to object
57
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HISTORY
• SIB began at 9 months• ABA home program for several years• Two
hospitalizations for severe behaviour at BCCH• Previously in school
with 2:1 aides
58
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BASELINETarget behaviours: busy all the time SIB: 3,000+
occurrences per day
• Head to object (glass, floors, walls, doors)• Hand to head
Aggression: Hundreds per day at school Environmental Destruction
(toys, furniture) Tantrum: Multiple times per day Stereotypy: All
the time
Home from school
59
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Head to object Hand to Head (2 in10s)
Ten count
Helmet application
successful…move onUnsuccessful
Move on
10s free
10s free
• Hourly visual schedule
• DRA for breathing
• Preference assessment
• Exercise
• Ignore other SIB
• Ignore ED
• Ignore AGG
60
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First Five Months: Head Directed SIB
61
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3952539525
3952639526
3952739527
3952839528
3952939529
3953039530
3953139531
3953239532
3953339533
3953439534
3953539535
3953639536
3953739537
3953839538
3953939539
3954039540
3954139541
3954239542
3954339543
3954439544
3954539545
3954639546
3954739547
3954839548
3954939549
3955039550
3955139551
3955239552
3955339553
3955439554
3955539555
3955639556
3955739557
3955839558
3955939559
3956039560
3956139561
3956239562
3956339563
3956439564
3956539565
3956639566
3956739567
3956839568
3956939569
3957039570
3957139571
3957239572
3957339573
3957439574
3957539575
3957639576
3957739577
3957839578
3957939579
3958039580
3958139581
3958239582
3958339583
3958439584
3958539585
3958639586
3958739587
3958839588
3958939589
3959039590
3959139591
3959239592
3959339593
3959439594
3959539595
3959639596
3959739597
3959839598
3959939599
3960039600
3960139601
3960239602
3960339603
3960439604
3960539605
3960639606
3960739607
3960839608
3960939609
3961039610
3961139611
3961239612
3961339613
3961439614
3961539615
3961639616
3961739617
3961839618
3961939619
3962039620
3962139621
3962239622
3962339623
3962439624
3962539625
3962639626
3962739627
3962839628
3962939629
3963039630
3963139631
3963239632
3963339633
3963439634
3963539635
3963639636
3963739637
3963839638
3963939639
3964039640
3964139641
3964239642
3964339643
3964439644
3964539645
3964639646
3964739647
3964839648
3964939649
3965039650
3965139651
3965239652
3965339653
3965439654
3965539655
3965639656
3965739657
3965839658
3965939659
3966039660
3966139661
3966239662
3966339663
3966439664
3966539665
3966639666
3966739667
3966839668
3966939669
3967039670
3967139671
3967239672
3967339673
3967439674
3967539675
3967639676
3967739677
3967839678
3967939679
3968039680
3968139681
3968239682
3968339683
3968439684
3968539685
3968639686
3968739687
3968839688
3968939689
3969039690
3969139691
3969239692
3969339693
3969439694
3969539695
3969639696
3969739697
3969839698
3969939699
3970039700
3970139701
3970239702
3970339703
3970439704
3970539705
3970639706
3970739707
3970839708
3970939709
3971039710
3971139711
3971239712
3971339713
3971439714
3971539715
3971639716
3971739717
3971839718
3971939719
3972039720
3972139721
3972239722
3972339723
3972439724
3972539725
3972639726
3972739727
3972839728
3972939729
3973039730
3973139731
3973239732
3973339733
3973439734
3973539735
3973639736
3973739737
3973839738
3973939739
3974039740
3974139741
3974239742
3974339743
3974439744
3974539745
3974639746
3974739747
3974839748
3974939749
3975039750
3975139751
3975239752
3975339753
3975439754
3975539755
3975639756
3975739757
3975839758
3975939759
3976039760
3976139761
3976239762
3976339763
3976439764
3976539765
3976639766
3976739767
3976839768
3976939769
3977039770
3977139771
3977239772
3977339773
3977439774
3977539775
3977639776
3977739777
3977839778
3977939779
3978039780
3978139781
3978239782
3978339783
3978439784
3978539785
3978639786
3978739787
3978839788
3978939789
3979039790
3979139791
3979239792
3979339793
3979439794
3979539795
3979639796
3979739797
3979839798
3979939799
3980039800
3980139801
3980239802
3980339803
3980439804
3980539805
3980639806
3980739807
3980839808
3980939809
3981039810
3981139811
3981239812
3981339813
3981439814
3981539815
3981639816
3981739817
3981839818
3981939819
3982039820
3982139821
3982239822
3982339823
3982439824
3982539825
3982639826
3982739827
3982839828
3982939829
3983039830
3983139831
3983239832
3983339833
3983439834
3983539835
3983639836
3983739837
3983839838
3983939839
3984039840
3984139841
3984239842
3984339843
3984439844
3984539845
3984639846
3984739847
3984839848
3984939849
3985039850
3985139851
3985239852
3985339853
3985439854
3985539855
3985639856
3985739857
TO begins
Tantrum frequency
Tantrum duration
Date
Tantrum data per day
Tantrum Frequency and Duration per day
1
0.75
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
5
1
7
0
0
0
0
0
0
3
4.75
0
0
3
12
0
0
0
0
0
0
0
0
5
10
1
0.2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
8
10
7
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
15
1
3
1
0
7
13
14
6
4
1.25
5
1
1
1
1
0.75
0
0
2
0.75
2
0.5
1
0.25
0
0
0
0
0
0
6
2
3
1.5
3
1.5
2
5.6
1
0.75
0
0
2
0.5
2
0.3
17
12.5
3
1
4
2.5
1
0.25
1
4
11
7
5
1.5
0
0
5
1
1
1
8
9
0
0
0
0
1
0.25
1
0.3
4
1
0
0
2
1
2
1
2
0.75
3
1.5
0
0
0
0
0
0
0
0
1
5
0
0
0
0
2
1
0
0
0
0
2
1.25
0
0
2
0.5
0
0
0
0
4
1.25
2
5
0
0
0
0
0
0
0
0
1
0.25
2
1.25
0
0
6
20.5
0
0
2
2.5
0
0
0
0
9
42
2
4
2
10.5
2
4
1
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
5.5
0
0
1
2
1
3
1
6
0
0
0
0
1
0.25
0
0
0
0
0
0
0
0
1
0.25
1
0.3
0
0
0
0
1
0.5
0
0
0
0
0
0
1
0.5
0
0
1
0.5
0
0
0
0
0
0
2
1.5
0
0
1
0.3
0
0
1
0.5
0
0
1
3
0
0
0
0
3
10.25
2
30
3
11.5
1
1
4
3.25
0
0
4
5.5
0
0
1
3
0
0
1
0.5
2
7
0
0
2
23
7
1
15
2
0
0
0
0
1
10
0
0
0
0
0
0
2
3.5
0
0
2
1.75
0
0
0
0
1
0.5
8
9.5
0
0
2
8
0
0
1
0.75
2
8
0
0
1
2
0
0
0
0
2
1.5
0
0
5
26
0
0
4
19
0
0
0
0
0
0
0
0
3
1
5
6.5
0
0
1
2
2
4
0
0
0
0
3
5
2
2.5
0
0
0
0
0
0
5
20
1
2
0
0
5
11
3
10
0
0
4
13
3
11
1
3
0
0
0
0
2
12
0
0
0
0
2
5
2
13
1
12
1
0.75
3
18
1
8
2
6
4
8.5
4
14.5
4
15
4
19.5
0
0
0
0
1
1
0
0
0
0
1
1
0
0
1
1
0
0
1
15
0
0
1
8
4
18
0
0
3
20
8
34.5
2
18
2
25
1
5
2
7
3
20
0
0
4
22
2
20
3
26
1
0.75
0
0
4
20
2
11
3
1
4
40
2
8
1
5
1
2
1
2
2
6.5
1
5
5
17
1
1
1
3
1
3
1
5
1
5
2
7
4
16
1
5
0
0
2
0
0
0
0
0
1
3
3
7
2
12
2
15
2
6
0
0
1
1
3
5.5
2
13
3
11
3
5
2
12
4
24
0
0
0
0
2
14
3
33
0
0
4
17.5
0
0
1
1
0
0
1
1
1
3
0
0
3
3
0
0
2
16
2
3
1
5
3
7
4
27
2
13
1
0
1
5
3
21
2
6
2
1.5
1
2
2
4
0
0
2
21
1
3
3
5
6
5.1
5
3
2
2.5
2
1
0
0
1
5
3
13
3
4
3
5
1
2
2
6.5
2
5
2
13
6
35
1
1
2
5
1
1
0
0
0
0
0
0
3
15
1
3
1
5
5
10
4
16
3
29
0
0
2
5.5
0
0
0
0
1
2
1
3
1
0.5
1
1
0
0
0
0
0
0
0
0
1
7
0
0
5
18.5
3
13
4
7
2
9
2
5
1
3
5
5
1
9
3
9
0
0
1
2
1
0.5
5
2
0
0
0
0
3
16
5
7.5
4
14
2
13
5
12
2
9
0
0
2
16
0
0
5
14.5
2
3
1
5
1
20
0
0
2
4
1
2
8
9
4
2.25
2
8
1
0.25
2
11
2
7
6
4.15
3
4
8
18
0
0
0
0
0
0
1
1.5
2
6
0
0
3
5.75
2
11
1
10
3
16.5
3
2
3
5.15
1
20
6
17
6
17.5
5
25.5
1
8
4
12
3
5
7
4
1
1
2
13
2
7
1
5.5
4
5.5
2
1
4
8
2
5.5
1
2.25
3
5.25
4
23
5
23
4
10.5
2
2
2
2.15
5
12
2
17
4
10
3
6
4
8
2
1.15
4
11.75
6
16.5
2
3
4
14.75
1
1
2
4.5
0
0
4
8
2
5.5
6
14
2
6
4
12.5
5
12
2
4
2
11
0
0
4
9.5
1
1
4
19
3
3.5
1
4
3
9
4
13
5
1.5
7
15.5
6
17
2
9
2
5
1
0.5
2
1
3
2.25
4
7.75
3
23
3
10
0
0
0
0
3
7
2
4
3
12
3
28
4
5
1
2
1
1
1
1
5
15
1
2
1
0.25
2
1
2
1.5
3
2.5
2
20.5
1
1
3
1
7
14.5
5
10
6
6.5
0
0
2
7.5
0
0
5
7.75
0
0
2
8
1
1.5
0
0
0
0
6
14.5
1
0.5
0
0
0
0
3
3
0
0
0
0
1
5
0
0
2
3.5
1
4
0
0
0
0
1
3
3
12
0
0
0
0
1
2
0
0
4
5.15
4
1.5
2
1.1
0
0
0
0
0
0
3
1
1
0.2
3
4
2
1.25
4
4
0
0
5
0.54
1
0.45
1
0.5
3
2.1
3
0.4
2
4.5
0
0
1
0.3
3
6.4
3
1.25
0
0
2
1.25
6
5
0
0
0
0
0
0
0
0
0
0
0
0
4
15
2
2
2
7.5
2
0.45
3
1.15
0
0
1
2
4
2.5
2
2.5
6
1.5
3
2
4
0.12
7
1.03
2
0.41
0
0
0
0
0
0
0
0
1
1
3
3.8
0
0
4
0.35
1
5
1
2
0
0
1
2.45
4
1.45
1
0.45
2
1.07
1
0.45
3
1.47
0
0
3
1.5
0
0
1
0.3
0
0
0
0
0
0
2
6
1
0.3
3
1.1
0
0
0
0
1
5
1
2
1
0.4
6
1.35
0
0
2
3.5
1
2.3
1
0.25
0
0
0
0
2
1.45
3
2.35
0
0
0
0
0
0
0
0
1
1
1
2.3
4
0.41
2
0.2
0
0
0
0
0
0
0
0
0
0
0
0
2
1.89
0
0
0
0
0
0
0
0
0
0
3
2.67
0
0
3
0.75
0
0
0
0
0
0
2
1
0
0
0
0
5
1.1
3
1.2
0
0
0
0
10
1.3
6
0.97
0
0
0
0
0
0
0
0
0
0
0
0
3
1.67
1
6
0
0
1
2
0
0
1
7
0
0
5
1.2
1
0.45
0
0
0
0
0
0
1
0.3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
2
0
0
0
0
0
0
1
0.58
0
0
0
0
4
2.1
0
0
0
0
0
0
1
4.25
0
0
0
0
2
3.25
0
0
2
4.25
0
0
0
0
disrup. behr
3912939129
3913039130
3913139131
3913239132
3913339133
3913439134
3913539135
3913639136
3913739137
3913839138
3913939139
3914039140
3914139141
3914239142
3914339143
3914439144
3914539145
3914639146
3914739147
3914839148
3914939149
3915039150
3915139151
3915239152
3915339153
3915439154
3915539155
3915639156
3915739157
3915839158
3915939159
3916039160
3916139161
3916239162
3916339163
3916439164
3916539165
3916639166
3916739167
3916839168
3916939169
3917039170
3917139171
3917239172
3917339173
3917439174
3917539175
3917639176
3917739177
3917839178
3917939179
3918039180
3918139181
3918239182
3918339183
3918439184
3918539185
3918639186
3918739187
3918839188
3918939189
3919039190
3919139191
3919239192
3919339193
3919439194
3919539195
3919639196
3919739197
3919839198
3919939199
3920039200
3920139201
3920239202
3920339203
3920439204
3920539205
3920639206
3920739207
3920839208
3920939209
3921039210
3921139211
3921239212
3921339213
3921439214
3921539215
3921639216
3921739217
3921839218
3921939219
3922039220
3922139221
3922239222
3922339223
3922439224
3922539225
3922639226
3922739227
3922839228
3922939229
3923039230
3923139231
3923239232
3923339233
3923439234
3923539235
3923639236
3923739237
3923839238
3923939239
3924039240
3924139241
3924239242
3924339243
3924439244
3924539245
3924639246
3924739247
3924839248
3924939249
3925039250
3925139251
3925239252
3925339253
3925439254
3925539255
3925639256
3925739257
3925839258
3925939259
3926039260
3926139261
3926239262
3926339263
3926439264
3926539265
3926639266
3926739267
3926839268
3926939269
3927039270
3927139271
3927239272
3927339273
3927439274
3927539275
3927639276
3927739277
3927839278
3927939279
3928039280
3928139281
3928239282
3928339283
3928439284
3928539285
3928639286
3928739287
3928839288
3928939289
3929039290
3929139291
3929239292
3929339293
3929439294
3929539295
3929639296
3929739297
3929839298
3929939299
3930039300
3930139301
3930239302
3930339303
3930439304
3930539305
3930639306
3930739307
3930839308
3930939309
3931039310
3931139311
3931239312
3931339313
3931439314
3931539315
3931639316
3931739317
3931839318
3931939319
3932039320
3932139321
3932239322
3932339323
3932439324
3932539325
3932639326
3932739327
3932839328
3932939329
3933039330
3933139331
3933239332
3933339333
3933439334
3933539335
3933639336
3933739337
3933839338
3933939339
3934039340
3934139341
3934239342
3934339343
3934439344
3934539345
3934639346
3934739347
3934839348
3934939349
3935039350
3935139351
3935239352
3935339353
3935439354
3935539355
3935639356
3935739357
3935839358
3935939359
3936039360
3936139361
3936239362
3936339363
3936439364
3936539365
3936639366
3936739367
3936839368
3936939369
3937039370
3937139371
3937239372
3937339373
3937439374
3937539375
3937639376
3937739377
3937839378
3937939379
3938039380
3938139381
3938239382
3938339383
3938439384
3938539385
3938639386
3938739387
3938839388
3938939389
3939039390
3939139391
3939239392
3939339393
3939439394
3939539395
3939639396
3939739397
3939839398
3939939399
3940039400
3940139401
3940239402
3940339403
3940439404
3940539405
3940639406
3940739407
3940839408
3940939409
3941039410
3941139411
3941239412
3941339413
3941439414
3941539415
3941639416
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3941939419
3942039420
3942139421
3942239422
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3942539425
3942639426
3942739427
3942839428
3942939429
3943039430
3943139431
3943239432
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3944039440
3944139441
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3944339443
3944439444
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3944639446
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3944839448
3944939449
3945039450
3945139451
3945239452
3945339453
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3945639456
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3946039460
3946139461
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3946339463
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3946939469
3947039470
3947139471
3947239472
3947339473
3947439474
3947539475
3947639476
3947739477
3947839478
3947939479
3948039480
3948139481
3948239482
3948339483
3948439484
3948539485
3948639486
3948739487
3948839488
3948939489
3949039490
3949139491
3949239492
3949339493
3949439494
3949539495
3949639496
3949739497
3949839498
3949939499
3950039500
3950139501
3950239502
3950339503
3950439504
3950539505
3950639506
3950739507
3950839508
3950939509
3951039510
3951139511
3951239512
3951339513
3951439514
3951539515
3951639516
3951739517
3951839518
3951939519
3952039520
3952139521
3952239522
3952339523
3952439524
3952539525
3952639526
3952739527
3952839528
3952939529
3953039530
3953139531
3953239532
3953339533
3953439534
3953539535
3953639536
3953739537
3953839538
3953939539
3954039540
3954139541
3954239542
3954339543
3954439544
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3955039550
3955139551
3955239552
3955339553
3955439554
3955539555
3955639556
3955739557
3955839558
3955939559
3956039560
3956139561
3956239562
3956339563
3956439564
3956539565
3956639566
3956739567
3956839568
3956939569
3957039570
3957139571
3957239572
3957339573
3957439574
3957539575
3957639576
3957739577
3957839578
3957939579
3958039580
3958139581
3958239582
3958339583
3958439584
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3958639586
3958739587
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3959039590
3959139591
3959239592
3959339593
3959439594
3959539595
3959639596
3959739597
3959839598
3959939599
3960039600
3960139601
3960239602
3960339603
3960439604
3960539605
3960639606
3960739607
3960839608
3960939609
3961039610
3961139611
3961239612
3961339613
3961439614
3961539615
3961639616
3961739617
3961839618
3961939619
3962039620
3962139621
3962239622
3962339623
3962439624
3962539625
3962639626
3962739627
3962839628
3962939629
3963039630
3963139631
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3963339633
3963439634
3963539635
3963639636
3963739637
3963839638
3963939639
3964039640
3964139641
3964239642
3964339643
3964439644
3964539645
3964639646
3964739647
3964839648
3964939649
3965039650
3965139651
3965239652
3965339653
3965439654
3965539655
3965639656
3965739657
3965839658
3965939659
3966039660
3966139661
3966239662
3966339663
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3966639666
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3966839668
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3967139671
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3967339673
3967439674
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3967639676
3967739677
3967839678
3967939679
3968039680
3968139681
3968239682
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3968439684
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3968639686
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3968939689
3969039690
3969139691
3969239692
3969339693
3969439694
3969539695
3969639696
3969739697
3969839698
3969939699
3970039700
3970139701
3970239702
3970339703
3970439704
3970539705
3970639706
3970739707
3970839708
3970939709
3971039710
3971139711
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3972039720
3972139721
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3973139731
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3975039750
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3976139761
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3977139771
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3977939779
3978039780
3978139781
3978239782
3978339783
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3979139791
3979239792
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3979439794
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3979639796
3979739797
3979839798
3979939799
3980039800
3980139801
3980239802
3980339803
3980439804
3980539805
3980639806
3980739807
3980839808
3980939809
3981039810
3981139811
3981239812
3981339813
3981439814
3981539815
3981639816
3981739817
3981839818
3981939819
3982039820
3982139821
3982239822
3982339823
3982439824
3982539825
3982639826
3982739827
3982839828
3982939829
3983039830
3983139831
3983239832
3983339833
3983439834
3983539835
3983639836
3983739837
3983839838
3983939839
3984039840
3984139841
3984239842
3984339843
3984439844
3984539845
3984639846
3984739847
3984839848
3984939849
3985039850
3985139851
3985239852
3985339853
3985439854
3985539855
3985639856
3985739857
TO begins
aggression
environmental destruction
Date
Frequency per day
Frequency of Disruptive Behavior per day
0
1
1
3
2
2
1
1
13
11
2
1
4
5
12
0
4
18
2
7
1
1
5
10
2
0
0
2
0
11
4
2
2
3
4
2
5
18
0
0
8
16
8
6
2
7
5
24
1
0
2
10
0
0
12
36
0
38
1
3
13
24
4
6
19
22
0
3
12
17
0
2
1
7
29
20
0
33
5
16
0
1
26
34
4
18
3
14
0
3
0
2
18
37
0
19
13
26
5
26
0
15
0
7
0
7
3
78
0
5
21
96
14
40
2
14
0
36
0
71
17
75
7
23
11
62
10
38
11
15
12
48
1
18
2
95
5
23
8
44
1
26
1
8
4
72
5
33
18
51
6
26
15
48
9
25
3
32
10
70
8
21
8
46
19
38
30
41
10
16
8
33
9
83
16
38
41
57
24
39
18
28
19
38
2
22
3
33
12
23
22
45
6
34
19
55
20
43
0
41
0
11
2
30
15
5
6
9
19
36
7
20
0
8
10
21
3
20
20
17
10
49
14
54
8
48
4
56
4
62
11
36
25
80
2
75
10
34
3
16
1
11
0
12
1
39
23
21
10
29
4
26
1
31
0
7
3
12
3
37
32
40
13
4
12
15
2
21
0
14
4
0
2
0
32
9
10
12
12
6
7
7
3
3
3
14
8
1
52
0
3
5
48
14
8
8
1
16
8
11
5
13
21
9
5
8
15
10
4
4
10
9
1
4
0
0
9
16
4
2
7
4
8
1
0
7
1
5
2
2
17
10
9
10
12
22
5
15
1
0
10
6
0
9
9
18
6
15
0
12
4
1
0
47
3
11
0
0
10
0
9
7
5
6
4
3
0
0
4
3
6
0
7
1
0
0
0
0
1
1
2
4
10
2
2
9
4
16
5
32
12
26
0
2
0
0
0
4
0
9
3
2
4
4
3
0
1
5
0
4
1
17
0
1
0
6
0
4
0
12
1
5
0
2
0
5
2
1
0
0
0
0
0
0
5
3
0
4
1
2
0
7
0
0
0
0
0
0
8
8
0
10
0
4
0
4
0
1
0
7
0
0
0
0
0
0
0
3
0
2
10
7
0
9
6
3
0
0
0
4
0
6
2
2
4
3
7
5
0
2
0
0
0
0
0
9
0
4
3
5
0
6
1
14
0
2
0
0
0
6
0
0
0
0
0
3
0
0
0
0
0
1
0
2
0
12
0
0
0
0
0
15
0
0
0
0
0
9
0
8
0
7
0
0
0
0
4
6
0
5
0
10
14
2
12
13
5
2
8
6
1
2
1
7
0
0
4
14
4
1
0
0
2
5
0
0
0
9
0
0
0
3
4
8
0
12
0
2
0
1
0
2
0
10
1
2
4
10
0
0
0
2
0
5
0
5
0
3
2
4
3
8
0
7
3
2
0
3
0
2
0
5
0
0
1
14
0
5
0
13
0
2
0
0
0
6
0
7
0
10
0
0
0
12
1
4
0
9
0
1
1
1
4
2
4
9
0
0
0
12
0
13
0
13
0
20
0
0
0
15
0
25
3
20
1
0
0
31
3
18
0
8
0
20
1
17
2
7
0
25
0
15
1
15
1
21
8
25
0
5
5
36
0
16
9
9
0
20
2
23
1
16
0
19
2
5
0
69
0
13
0
6
5
15
0
23
5
38
1
42
0
53
4
19
0
28
9
14
1
35
5
29
3
30
1
15
4
30
8
41
11
19
12
31
9
34
0
10
1
36
1
6
2
13
0
21
1
7
1
9
0
2
3
29
1
10
0
11
0
10
1
8
0
12
0
5
0
4
1
16
0
19
2
15
1
6
1
4
0
4
0
20
2
22
0
8
2
6
5
11
3
11
3
8
3
42
0
8
0
2
10
7
1
9
7
16
5
10
0
9
5
12
1
7
0
5
0
0
3
8
0
8
0
8
0
29
0
1
0
5
1
4
1
11
0
8
1
9
0
7
0
18
0
12
4
15
0
6
0
15
7
3
0
13
0
6
6
3
0
11
1
2
0
8
0
4
1
3
3
6
3
8
4
10
1
10
4
5
4
9
4
12
0
8
1
1
0
4
10
5
0
8
16
4
3
21
0
12
2
13
1
10
0
3
4
4
1
6
5
6
8
15
11
9
2
8
2
13
1
8
4
11
7
2
5
4
4
5
3
5
0
9
3
4
6
16
0
7
2
3
4
9
0
6
5
5
9
11
11
3
4
0
5
0
7
10
20
6
5
0
11
12
1
7
5
3
4
10
3
6
5
5
5
4
3
5
2
0
5
7
4
7
3
10
1
4
0
4
0
0
0
4
5
3
13
3
21
5
8
0
3
1
1
3
4
1
2
3
5
7
4
7
1
8
3
6
1
0
0
0
3
1
0
2
3
0
0
0
1
0
0
1
2
4
0
0
1
1
0
0
4
2
3
0
0
1
0
0
0
2
1
0
0
0
0
1
1
0
1
1
0
0
0
1
0
1
0
3
0
0
0
0
0
0
0
3
1
1
0
5
2
0
0
0
0
0
0
1
2
0
0
0
0
1
2
0
0
0
0
1
1
0
0
1
1
0
0
0
0
0
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
3
3
3
0
0
0
2
0
0
1
5
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
4
0
0
1
2
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
3
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
2
0
0
0
2
0
1
0
5
0
1
0
3
0
1
0
0
0
0
0
1
0
0
0
2
0
0
0
2
0
2
0
0
0
3
0
0
1
3
0
1
0
0
1
0
0
0
0
0
0
1
0
2
0
0
0
1
0
1
0
2
0
1
0
0
0
0
0
1
0
0
0
0
0
4
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
3
0
3
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
17
0
17
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
3
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
#TO
39134
39135
39136
39137
39138
39139
39140
39141
39142
39143
39144
39145
39146
39147
39148
39149
39150
39151
39152
39153
39154
39155
39156
39157
39158
39159
39160
39161
39162
39163
39164
39165
39166
39167
39168
39169
39170
39171
39172
39173
39174
39175
39176
39177
39178
39179
39180
39181
39182
39183
39184
39185
39186
39187
39188
39189
39190
39191
39192
39193
39194
39195
39196
39197
39198
39199
39200
39201
39202
39203
39204
39205
39206
39207
39208
39209
39210
39211
39212
39213
39214
39215
39216
39217
39218
39219
39220
39221
39222
39223
39224
39225
39226
39227
39228
39229
39230
39231
39232
39233
39234
39235
39236
39237
39238
39239
39240
39241
39242
39243
39244
39245
39246
39247
39248
39249
39250
39251
39252
39253
39254
39255
39256
39257
39258
39259
39260
39261
39262
39263
39264
39265
39266
39267
39268
39269
39270
39271
39272
39273
39274
39275
39276
39277
39278
39279
39280
39281
39282
39283
39284
39285
39286
39287
39288
39289
39290
39291
39292
39293
39294
39295
39296
39297
39298
39299
39300
39301
39302
39303
39304
39305
39306
39307
39308
39309
39310
39311
39312
39313
39314
39315
39316
39317
39318
39319
39320
39321
39322
39323
39324
39325
39326
39327
39328
39329
39330
39331
39332
39333
39334
39335
39336
39337
39338
39339
39340
39341
39342
39343
39344
39345
39346
39347
39348
39349
39350
39351
39352
39353
39354
39355
39356
39357
39358
39359
39360
39361
39362
39363
39364
39365
39366
39367
39368
39369
39370
39371
39372
39373
39374
39375
39376
39377
39378
39379
39380
39381
39382
39383
39384
39385
39386
39387
39388
39389
39390
39391
39392
39393
39394
39395
39396
39397
39398
39399
39400
39401
39402
39403
39404
39405
39406
39407
39408
39409
39410
39411
39412
39413
39414
39415
39416
39417
39418
39419
39420
39421
39422
39423
39424
39425
39426
39427
39428
39429
39430
39431
39432
39433
39434
39435
39436
39437
39438
39439
39440
39441
39442
39443
39444
39445
39446
39447
39448
39449
39450
39451
39452
39453
39454
39455
39456
39457
39458
39459
39460
39461
39462
39463
39464
39465
39466
39467
39468
39469
39470
39471
39472
39473
39474
39475
39476
39477
39478
39479
39480
39481
39482
39483
39484
39485
39486
39487
39488
39489
39490
39491
39492
39493
39494
39495
39496
39497
39498
39499
39500
39501
39502
39503
39504
39505
39506
39507
39508
39509
39510
39511
39512
39513
39514
39515
39516
39517
39518
39519
39520
39521
39522
39523
39524
39525
39526
39527
39528
39529
39530
39531
39532
39533
39534
39535
39536
39537
39538
39539
39540
39541
39542
39543
39544
39545
39546
39547
39548
39549
39550
39551
39552
39553
39554
39555
39556
39557
39558
39559
39560
39561
39562
39563
39564
39565
39566
39567
39568
39569
39570
39571
39572
39573
39574
39575
39576
39577
39578
39579
39580
39581
39582
39583
39584
39585
39586
39587
39588
39589
39590
39591
39592
39593
39594
39595
39596
39597
39598
39599
39600
39601
39602
39603
39604
39605
39606
39607
39608
39609
39610
39611
39612
39613
39614
39615
39616
39617
39618
39619
39620
39621
39622
39623
39624
39625
39626
39627
39628
39629
39630
39631
39632
39633
39634
39635
39636
39637
39638
39639
39640
39641
39642
39643
39644
39645
39646
39647
39648
39649
39650
39651
39652
39653
39654
39655
39656
39657
39658
39659
39660
39661
39662
39663
39664
39665
39666
39667
39668
39669
39670
39671
39672
39673
39674
39675
39676
39677
39678
39679
39680
39681
39682
39683
39684
39685
39686
39687
39688
39689
39690
39691
39692
39693
39694
39695
39696
39697
39698
39699
39700
39701
39702
39703
39704
39705
39706
39707
39708
39709
39710
39711
39712
39713
39714
39715
39716
39717
39718
39719
39720
39721
39722
39723
39724
39725
39726
39727
39728
39729
39730
39731
39732
39733
39734
39735
39736
39737
39738
39739
39740
39741
39742
39743
39744
39745
39746
39747
39748
39749
39750
39751
39752
39753
39754
39755
39756
39757
39758
39759
39760
39761
39762
39763
39764
39765
39766
39767
39768
39769
39770
39771
39772
39773
39774
39775
39776
39777
39778
39779
39780
39781
39782
39783
39784
39785
39786
39787
39788
39789
39790
39791
39792
39793
39794
39795
39796
39797
39798
39799
39800
39801
39802
39803
39804
39805
39806
39807
39808
39809
39810
39811
39812
39813
39814
39815
39816
39817
39818
39819
39820
39821
39822
39823
39824
39825
39826
39827
39828
39829
39830
39831
39832
39833
39834
39835
39836
39837
39838
39839
39840
39841
39842
39843
39844
39845
39846
39847
39848
39849
39850
39851
39852
39853
39854
39855
39856
39857
TO begins
helmet applications
Date
Frequency per day
Frequency of time out/helmet applications
4
14
6
17
8
5
5
3
3
10
9
5
4
6
4
6
13
1
16
3
10
3
9
15
5
6
2
13
1
4
2
7
12
2
4
0
5
2
0
0
0
12
11
6
5
4
0
0
4
0
14
7
1
3
3
4
4
3
1
0
0
0
0
0
4
0
0
8
0
2
0
0
0
2
3
3
1
5
2
6
7
4
3
7
4
4
1
0
1
5
1
1
5
1
1
0
2
4
0
4
0
0
4
0
2
5
0
3
4
1
3
8
2
1
0
0
0
2
11
8
0
4
0
0
8
5
4
3
10
2
0
1
3
1
0
2
0
4
2
1
1
12
0
3
0
0
1
0
1
0
1
0
0
4
0
0
0
1
0
1
1
0
1
2
0
1
0
5
0
2
0
0
4
3
8
2
7
0
0
4
4
0
1
4
2
2
5
4
2
3
7
2
0
1
6
1
5
0
1
0
12
1
0
1
4
2
2
2
4
2
3
2
8
2
4
3
0
3
0
4
8
1
0
3
2
0
2
0
0
1
4
2
4
0
1
3
1
2
2
0
2
0
1
1
4
1
3
4
0
2
0
2
2
3
3
3
0
2
2
4
4
5
4
1
1
1
5
3
8
2
3
10
6
7
1
0
3
0
5
3
6
3
0
0
1
0
6
2
0
3
2
2
2
4
0
0
0
1
1
1
1
0
0
3
0
0
1
3
1
6
2
0
1
4
5
2
5
0
3
1
3
4
4
0
3
0
1
0
1
3
2
3
0
10
3
1
3
5
4
0
2
2
2
3
2
5
0
3
0
2
2
6
6
5
6
2
6
3
2
1
4
1
2
4
3
2
3
1
0
3
1
1
1
3
8
0
0
4
0
0
1
1
2
1
3
0
1
0
0
0
0
2
3
1
0
1
4
5
6
0
2
1
3
2
1
0
6
1
4
0
2
0
9
0
1
0
0
3
1
1
3
5
2
2
1
0
5
2
1
5
0
3
0
2
1
0
1
5
3
6
3
2
7
5
11
10
3
5
5
2
0
8
0
1
5
2
1
2
1
1
1
3
1
0
2
3
4
7
2
9
3
7
8
2
7
1
3
0
2
2
8
5
6
13
5
8
0
3
5
16
5
3
5
10
11
15
11
9
5
1
8
5
13
15
14
2
5
15
15
12
10
10
13
6
7
13
15
16
9
6
7
17
6
5
19
7
12
4
14
6
11
0
11
2
4
4
6
4
3
5
7
3
5
7
9
8
7
4
8
5
7
2
8
5
4
10
6
8
6
3
8
6
10
11
8
15
12
20
7
4
24
10
27
9
10
15
16
11
11
17
12
8
8
11
5
6
20
13
20
9
20
12
6
13
17
18
10
14
11
9
5
15
6
13
9
7
16
16
18
22
17
16
17
3
14
18
11
17
9
6
18
11
23
17
9
6
11
7
4
9
9
4
8
8
7
6
3
3
4
4
8
6
6
9
3
4
12
13
10
9
14
8
4
2
4
7
4
3
3
7
3
7
8
9
6
8
8
14
3
9
7
7
4
7
5
10
5
10
4
3
2
1
3
9
7
11
6
6
5
5
6
1
7
2
4
8
6
0
10
4
1
2
3
5
4
7
7
3
3
0
3
1
2
5
3
1
5
7
6
6
1
4
SIB in TO
3978139781
3978239782
3978339783
3978439784
3978539785
3978639786
3978739787
3978839788
3978939789
3979039790
3979139791
3979239792
3979339793
3979439794
3979539795
3979639796
3979739797
3979839798
3979939799
3980039800
3980139801
3980239802
3980339803
3980439804
3980539805
3980639806
3980739807
3980839808
3980939809
3981039810
3981139811
3981239812
3981339813
3981439814
3981539815
3981639816
3981739817
3981839818
3981939819
3982039820
3982139821
3982239822
3982339823
3982439824
3982539825
3982639826
3982739827
3982839828
3982939829
3983039830
3983139831
3983239832
3983339833
3983439834
3983539835
3983639836
3983739837
3983839838
3983939839
3984039840
3984139841
3984239842
3984339843
3984439844
3984539845
3984639846
3984739847
3984839848
3984939849
3985039850
3985139851
3985239852
3985339853
3985439854
3985539855
3985639856
3985739857
body to object
head-directed
Date
Frequency per day
Daily Frequency of self-injury in time out
1
377
29
293
33
273
9
169
21
551
45
146
61
78
42
0
16
85
3
317
0
148
0
161
0
93
42
159
49
214
31
340
79
284
107
192
5
92
4
180
7
327
12
247
1
36
5
207
42
122
3
210
2
118
0
46
0
589
14
347
11
410
17
116
0
73
45
273
1
99
0
17
0
132
23
378
2
335
42
745
1
43
1
144
1
269
7
240
0
201
0
6
0
159
0
4
0
232
0
188
4
346
0
0
0
292
1
63
0
12
0
13
0
79
0
379
0
56
2
190
2
197
9
62
0
44
0
0
14
774
0
6
0
12
0
221
0
172
0
26
51
157
17
382
5
338
5
108
0
17
0
75
TO.total SIB
3978112
3978213
3978310
397849
3978514
397868
397874
397882
397894
397907
397914
397923
397933
397947
397953
397967
397978
397989
397996
398008
398018
3980214
398033
398049
398057
398067
398074
398087
398095
3981010
398115
3981210
398134
398143
398152
398161
398173
398189
398197
3982011
398216
398226
398235
398245
398256
398261
398277
398282
398294
398308
398316
398320
3983310
398344
398351
398362
398373
398385
398394
398407
398417
398423
398433
398440
398453
398461
398472
398485
398493
398501
398515
398527
398536
398546
398551
398564
39857
total self-injury
time out frequency
Date
Frequency per day
Frequency time out v. total frequency of self-injury in time
out
378
322
306
178
572
191
