The self-injury hypothesis: addressing a neurologist's concerns

Coulter (1991) concluded that a "poor study design" (p. 81) was used and my hypothesis was unproven. My article was not an experimental study in the sense of presenting experimental data intended to confirm or deny my hypothesis. Rather, it: 1. Described remarkable similarity between movements in patients with mental retardation during self-injury episodes and reports in the literature of involuntary movements during confirmed frontal lobe seizures; 2. Pointed out that the movements by some patients with mental retardation were so frequent and/or forceful that self-injury resulted; 3. Presented the hypothesis that the movements by patients with mental retardation may, in some cases, be involuntary and due to undiagnosed frontal lobe seizures; and 4. Suggested that if this hypothesis were correct, then one ought to consider what sort of treatment approaches might reduce the incidence/severity of frontal lobe seizure episodes. I agree that a well-designed experimental study to test my hypothesis would be very desirable. The preceding literature review has shown how difficult it would be using present methods to do a definitive study that rigorously confirms or rejects my hypothesis. Other approaches might be considered for testing my hypothesis with persons who are unable to give informed consent. One approach using rigorous observable criteria was suggested. In the interim, it seemed worthwhile to present my hypothesis to mental retardation professionals with the hope that others would consider this possibility and its implications for diagnosis and treatment, and the hope that some patients might benefit sooner rather than later. I appreciate Coulter's (1991) comments because they provided an opportunity to clarify potential misunderstandings. It is possible that other readers have had similar concerns, and I trust that this is the appropriate forum for addressing such matters.