Monday, 17 August 2015

Sibling death by defenestration: a case report

The case report published by Osman Sabuncuoglu and colleagues [1] (open-access) highlighting the extremes of certain high-risk behaviours potentially associated with autism is the topic of today's brief post.

Detailing the very saddest of outcomes whereby a young boy diagnosed with autism and "aggression, violence and poor behavioral control" threw his 18-month old sister out of a window (defenestration) causing her death, the authors draw attention to several issues tied into the extremes of aggression appearing alongside autism and the legal implications of such behaviour under such circumstances.

The authors describe how due to the gravity of the issues faced by the autistic child (including a degree of learning disability) "the child had no preconception of consequences of his behavior" already with a history of violence towards caregivers before the very unfortunate episode with his sister. The subsequent criminal investigation carried out on this incident was eventually dropped "on the grounds of incompetence due to insanity and being below the age of criminal responsibility."

Treading carefully so as not to make any sweeping generalisations about the very heterogeneous autism spectrum, the Sabuncuoglu report highlights how aggression can manifest alongside [some] autism and brings into focus the plight of quite a few families dealing with such issues day to day. Judging by the lack of peer-reviewed literature on this topic, I am assuming that the extent and effects of the aggression detailed by Sabuncuoglu is thankfully pretty rare(?) (in terms of endangering life for example) but that isn't to say that it hasn't happened before (see here).

"The most distinctive symptoms that led to the death of the sibling seem to be a high level of aggression, low level of impulse control and severe form of disability." Alongside the idea that there may be various strategies that can be employed to potentially off-set such variables (see here and see here for examples), I'd be minded to suggest that further investigations on such factors such be a research priority in terms of improving quality of life for those presenting with such issues and their family and loved ones.

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[1] Sabuncuoglu O. et al. Sibling death after being thrown from window by brother with autism: defenestration an emerging high-risk behavior. Case Reports in Psychiatry. 2015. July 21.

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ResearchBlogging.org Osman Sabuncuoglu, Mustafa Yasin IRMAK, Nagehan Ucok Demir, Duygu Murat, Can Tumba, & Yuksel Yilmaz (2015). Sibling death after being thrown from window by brother with autism: defenestration an emerging high-risk behavior Case Reports in Psychiatry