Стереотипное и самоповреждающее поведение у детей с нарушениями в развитии

Стереотипное поведение определяется как ритмично повторяющиеся движения, неизменные по форме и амплитуде. Они являются естественными на определенных этапах нейро-мышечного созревания в раннем возрасте, однако при некоторых расстройствах развития они приобретают патологические формы, длятся значительное время и препятствуют повседневной адаптации, вплоть до физического самоповреждения. Стереотипии наблюдаются при самых разнообразных нарушениях — аутизме, умственной отсталости, слепоте, глухоте, а также у детей, воспитывающихся в домах ребенка. Общим для всех этих разнородных состояний является наличие какой-либо депривации: сенсорной или социальной. Предполагают, что дети с аутизмом и дети с умственной отсталостью испытывают проблемы переработки и соотнесения зрительных, слуховых и тактильно-кинестетических сигналов, и поэтому они подвергаются своего рода депривации, подобно слепым и глухим детям. Патогенез стереотипного поведения связывают с аномальным функционированием дофамин-эргических и ГАМК-эргических нейронов системы фронтальная кора-таламус-мозжечок, развитие которой растянуто на несколько лет жизни и крайне чувствительно к обеднению окружающей среды.

1. Международная классификация болезней (10-й пересмотр). Классификация психических и поведенческих расстройств. Клинические описания и указания по диагностике. СПб: Оверлайд. 1994. 300 с.
2. Adams G.L., Tallon R.J., Stangl J.M. Environmental influences on self-stimulatory behavior // American Journal of Mental Deficiency. 1980. Vol. 85, Iss. 2. P. 171—175.
3. Aiken J.M., Salzberg C.L. The effects of a sensory extinction procedure on stereotypic sounds of two autistic children // Journal of Autism and Developmental  Disorders. 1984. Vol. 14, Iss. 3. P. 291—299.
4. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. / American Psychiatric Association. Washington DC: American Psychiatric Pub. 2000. 943 p.
5. Arpino C. Brain damage in preterm infants: etiological pathways / C. Arpino, L. D'argenzio, Ticconi C., Di Paolo A., Stellin V., Lopez L., Curatolo P. // Annali dell'Istituto superiore di sanità. 2005. Vol. 41, Iss. 2. P. 229—237.
6. Bartlet L.B., Limsila P. Severe deprivation in childhood: a case report from Thailand // The British Journal of Psychiatry. 1992. Vol. 161, Iss. 3. P. 412—414.
7. Bauer P.M. Cerebellar volume and cognitive functioning in children who experienced early deprivation / P.M. Bauer, J.L. Hanson, R.K. Pierson, R.J. Davidson, S.D. Pollak // Biological psychiatry. 2009. Vol. 66, Iss. 12. P. 1100—1106.
8. Berkson G., Mason W.A. Stereotyped movements of mental defectives: The effects of toys and the character of the acts // American Journal of Mental Deficiency. 1964. Vol. 68. P. 511—524.
9. Boice R., Kraemer E.A. Stereotypies as behavioral indices in mental patients // Journal of Nonverbal Behavior. 1981. Vol. 6. P. 30—45.
10. Bornstein E., Smith D.W. Effect of visual and auditory stimuli on self-stimulatory behavior: A case study. Research & the Retarded. 1976. Vol. 3, Iss. 2. P. 40—44.
11. Bos K.J. Stereotypies in Children With a History of Early Institutional Care / K.J. Bos, Jr.C.H. Zeanah, A.T. Smyke, N.A. Fox, C.A. Nelson // Arch Pediatr Adolesc Med.. 2010. Vol. 164, Iss. 5. P. 406—411.
12. Bourreau Y. Validation of the repetitive and restricted behaviour scale in autism spectrum disorders / Y. Bourreau, S. Roux, M. Gomot, F. Bonnet-Brilhault, C. Barthe´le´my // Eur Child Adolesc Psychiatry. 2009. Vol. 18. P. 675—682.
13. Bower J.M., Kassel J. Variability in tactile projection patterns to cerebellar folia crus IIA of the Norway rat // Journal of comparative neurology. 1990. Vol. 302, Iss. 4. P. 768—778.
14. Bright T., Bittick K., Fleeman B. Reduction of self-injurious behavior using sensory integrative techniques // American Journal of Occupational Therapy. 1981. Vol. 35. P. 167—172.
15. Brown R. Are there "autistic-like" features in congenitally blind children? / R. Brown, R.P. Hobson, A. Lee, J. Stevenson // Journal of Child Psychology and Psychiatry. 1997. Vol. 38. P. 693—703.
16. Carcani-Rathwell I., Rabe-Hasketh S., Santosh P.J. Repetitive and stereotyped behaviours in pervasive developmental disorders // Journal of Child Psychology and Psychiatry. 2006. Vol. 47. P. 573—581.
17. Carter J.C., Capone G.T., Kaufmann W.E. Neuroanatomic correlates of autism and stereotypy in children with Down syndrome // Neuroreport. 2008. Vol. 19. P. 653—656.
18. Chao H.T. Dysfunction in GABA signalling mediates autism-like stereotypies and Rett syndrome phenotypes / H.T. Chao, H. Chen, R.C. Samaco, M. Xue, M. Chahrour, J. Yoo, H.Y. Zoghbi // Nature. 2010. V. 468, Iss. 7321. P. 263—269.
19. Cheal M.L. Amphetamine-induced stereotypy in the Mongolian gerbil (Meriones unguiculatus) / M.L. Cheal, P. Berman, H. Kleinberg, H. Shapiro, L.C. Volpe // Behavioral Biology. 1978. Vol. 23, Iss. 4. P. 469—476.
20. Chen R.M. Ophthalmic manifestations of Smith-Magenis syndrome / R.M. Chen, J.R. Lupski, F. Greenberg, R.A. Lewis // Ophthalmology. 1996. Vol. 103, Iss. 7. P. 1084—1091.
21. Cornish K., Pigram J. Developmental and behavioural characteristics of Cri du Chat syndrome // Archives of Disease in Childhood. 1996. Vol. 75, Iss. 5. P. 448—450.
22. Dantzer R. Behavioral, physiological and functional aspects of stereotyped behavior: a review and a re-interpretation // Journal of Animal Science. 1986. Vol. 62, Iss. 6. P. 1776—1786.
23. Darin N., Hanner P., Thiringer K. Changes in prevalence, aetiology, age at detection, and associated disabilities in preschool children with hearing impairment born in Göteborg // Developmental Medicine & Child Neurology. 1997. Vol. 39, Iss. 12. P. 797—802.
24. De Lissavoy V. Head banging in early childhood // The Journal of Pediatrics. 1961. Vol. 58. P. 803—805.
25. Didden R., Korzilius H., Curfs L.M. Skin-Picking in Individuals with Prader-Willi Syndrome: Prevalence, Functional Assessment, and its Comorbidity with Compulsive and Self-Injurious Behaviours // Journal of Applied Research in Intellectual Disabilities. 2007. Vol. 20, Iss. 5. P. 409—419.
26. Ek U. Relationship between blindness due to retinopathy of prematurity and autistic spectrum disorders: a population based study / U. Ek, E. Fernell, L. Jacobson, C. Gillberg // Dev. Med. Child Neurol. 1998. Vol. 40. P. 297—301.
27. Fazzi E. Stereotyped behaviours in blind children / E. Fazzi, J. Lanners, S. Danova, O. Ferrarri-Ginevra, C. Gheza, A. Luparia, G. Lanzi // Brain and Development. 1999. Vol. 21, Iss. 8. P. 522—528.
28. Fog R. Stereotyped and non-stereotyped behaviour in rats induced by various stimulant drugs // Psychopharmacologia. 1969. Vol. 14, Iss. 4. P. 299—304.
29. Forehand R., Baumeister A.A. Rate of stereotyped body rocking of severe retardates as a function of frustration of goal-directed behavior // Journal of Abnormal Psychology. 1971. Vol. 78, Iss. 1. P. 35—42.
30. Forehand R., Baumeister A.A. Stereotyped body rocking as a function of situation, IQ, and time // Journal of Clinical Psychology. 1971. Vol. 27. P. 324—326.
31. Gal E., Dyck M.J. Stereotyped Movements Among Children Who Are Visually Impaired // Journal of Visual Impairment & Blindnes. 2009. Vol. 103, № 11. P. 754—765.
32. Gal E., Dyck M.J., Passmore A. Relationships between stereotyped movements and sensory processing disorders in children with and without developmental or sensory disorders // American Journal of Occupational Therapy. 2010. Vol. 64, № 3. P. 453—461.
33. Gal E., Dyck M.J., Passmore A. The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities // Research in Developmental Disabilities. 2009. Vol. 30, Iss. 2. P. 342—352.
34. Gal E., Dyck M., Passmore A. Sensory differences and stereotyped movements in children with autism // Behavior Change. 2002. Vol. 19, Iss. 4. P. 207—219.
35. Georgiades S. Structure of the autism symptom phenotype: a proposed multidimensional model / S. Georgiades, P. Szatmari, L. Zwaigenbaum, E. Duku, S. Bryson, W. Roberts, J. Goldberg, W. Mahoney // Journal of the American Academy of Child & Adolescent Psychiatry. 2007. Vol. 46, Iss. 2. P. 188—196.
36. Goldman S. Motor stereotypies in children with autism and other developmental disorders / S. Goldman, C. Wang, M.W. Salgado, P.E. Greene, M. Kim, I. Rapin // Developmental Medicine & Child Neurology. 2009. Vol. 51, Iss. 1. P. 30—38.
37. Goodman R., Minne C. Questionnaire screening for comorbid pervasive developmental disorders in congenitally blind children: A pilot study // Journal of Autism and Developmental Disorders. 1995. Vol. 25, Iss. 2. P. 195—203.
38. Harris K.M., Mahone E.M., Singer H.S. Nonautistic motor stereotypies: Clinical features and longitudinal follow-up // Pediatric Neurology. 2008. Vol. 38, Iss. 4. P. 267—272.
39. Hered R.W. Ophthalmologic features of Prader-Willi syndrome / R.W. Hered, S. Rogers, Y.F. Zang, A.W. Biglan // Journal of pediatric ophthalmology and strabismus. 1988. Vol. 25, Iss. 3. P. 145.
40. Hessl D. Brief report: aggression and stereotypic behavior in males with fragile X syndrome — moderating secondary genes in a «single gene» disorder / D. Hessl, F. Tassone, L. Cordeiro, K. Koldewyn, C. McCormick, C. Green, R. J. Hagerman // Journal of autism and developmental disorders. 2008. Vol. 38, Iss. 1. P. 184—189.
41. Humphry R. Young children's occupations: Explicating the dynamics of developmental processes // American Journal of Occupational Therapy. 2002. Vol. 41, Iss. 6. P. 171—179.
42. Hutt C., Hutt S.J. Heart rate variability: The adaptive consequences of individual differences and state changes // V. Reynolds, N. Blurton-Jones (Eds.), Human Behaviour and Adaptation. London: Taylor & Francis, 1978. 171—189 p.
43. Jan J.E., Freeman R.D., Scott E.P. Visual impairment in children and adolescents. New York, NY: Grune & Stratton, 1977. 418 p.
44. Jinnah H.A. Ocular motor dysfunction in Lesch-Nyhan disease / Jinnah H.A., Lewis R.F., Visser J.E., Eddey G.E., Barabas G., Harris J.C. // Pediatric neurology. 2001. Vol. 24, Iss. 3. P. 200—204.
45. Jure R., Rapin I., Tuchman R.F. Hearing-impaired autistic children // Developmental Medicine and Child Neurology. 1991. Vol. 33, Iss. 12. P. 1062—1072.
46. Kates W.R., Lanham D.C., Singer H.S. Frontal white matter reductions in healthy males with complex stereotypies // Pediatr Neurol. 2005. Vol. 32, Iss. 2. P. 109—112.
47. Kenworthy L., Park T., Charnas L.R. Cognitive and behavioral profile of the oculocerebrorenal syndrome of Lowe // American journal of medical genetics. 1993. Vol. 46, Iss. 3. P. 297—303.
48. Kiani R., Miller H. Sensory impairment and intellectual disability // Advances in psychiatric treatment. 2010. Vol. 16. P. 228—235.
49. Knoors H., Vervloed M.P.J. Educational programming for deaf children with multiple disabilities / Marschark M., Spencer P.E. (ed.). // Oxford handbook of deaf studies, language and education. Oxford: Oxford University Press; 2003. P. 82—96.
50. Koegel R.L. Increasing spontaneous play by suppressing self-stimulation in autistic children / Koegel R.L., Firestone P.B., Kramme K.W., Dunlap G. // Journal of Applied Behavior Analysis. 1974, Vol. 7, Iss. 2. P. 521—528.
51. Kravitz H., Boehm J.J. Rhythmic habit patterns in infancy: Their sequence, age of onset, and frequency // Child Development. 1971. Vol. 42, Iss. 2. P. 399—413.
52. Kulisevsky J. Unilateral Parkinsonism and stereotyped movements following a right lenticular infarction / Kulisevsky J., Berthier M.L., Avila A., Roig C. // Mov Disord. 1996, Vol. 11. Iss. 6. P. 752—754.
53. Lalonde R., Manseau M., Botez M.I. Exploration and habituation in Purkinje cell degeneration mutant mice // Brain Res. 1989. Vol. 479. P. 201—203.
54. Levy D.M. On the problem of movement restraint: Tics, stereotyped movements, and hyperactivity // American Journal of Orthopsychiatry. 1944. Vol. 1. P. 644—671.
55. Lewis M., Kim S.J. The pathophysiology of restricted repetitive behavior // Journal of neurodevelopmental disorders. 2009. Vol. 1, Iss. 2. P. 114—132.
56. Lewis M.H. Plasma HVA in adults with mental retardation and stereotyped behavior: Biochemical evidence for a dopamine deficiency model / Lewis M.H., Bodfish J.W., Powell S.B., et al // Am J Ment Retard. 1996. Vol. 100, Iss. 4. P. 413—418.
57. Lourie R.S. The role of rhythmic patterns in childhood // American Journal of Psychiatry. 1949. Vol. 105. P. 653—660.
58. Lovaas O.I., Newsom C., Hickman C. Selfstimulatory behavior and perceptual reinforcement // Journal of Applied Behavior Analysis. 1987. Vol. 20, Iss. 1. P. 45—68.
59. Mahone E.M. Repetitive arm and hand movements (complex motor stereotypies) in children / Mahone E.M., Bridges D., Prahme C., Singer H // J Pediatr. 2004. Vol. 145, Iss. 3. P. 391—395.
60. Malm J. Cognitive impairment in young adults with infratentorial infarcts / Malm J., Kristensen B., Karlsson T., Carlberg B., Fagerlund M., Olsson T. // Neurology. 1998. Vol. 51, Iss. 2. P. 443—440.
61. Maraganore D.M., Lees A.J., Marsden C.D. Complex stereotypies after right putaminal infarction: A case report // Movement Disorders. 1991. Vol. 6, Iss. 4. P. 358—361.
62. Martin S.C., Wolters P.L., Smith A.C. Adaptive and maladaptive behavior in children with Smith-Magenis Syndrome // Journal of autism and developmental disorders. 2006. Vol. 36, Iss. 4. P. 541—552.
63. Mason G.J. Stereotypies: a critical review // Animal Behaviour. 1991. Vol. 41, Iss. 6. P. 1015—1037.
64. Mason G.J., Turner M.A. Mechanisms involved in the development and control of stereotypies // Behavior and evolution / Bateson P.P.G., Klopfer P.H., et al., editors. — New York: Plenum Press. 1993. P. 53—85.
65. Matson J.L. Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH–II) / J.L. Matson, M. Hamilton, D. Duncan, J. Bamburg, B. Smiroldo, S. Anderson, C. Baglio // Research in Developmental Disabilities. 1997. Vol. 18, Iss. 6. P. 457—469.
66. McClintock K., Hall S., Oliver C. Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study // Journal of Intellectual Disability Research. 2003. Vol. 47, Iss. 6. P. 405—416.
67. McHugh E., Lieberman L. The impact of developmental factors on stereotypic rocking of children with visual impairments // Journal of Visual Impairment and Blindness. 2003. Vol. 97, Iss. 8. P. 453—474.
68. McHugh E., Pyfer J. The development of rocking among children who are blind // Journal of Visual Impairment & Blindness. 1999. Vol. 93, Iss. 2. P. 82—103.
69. Miller K.A., Garner J.P. Mench J.A. The test-retest reliability of four behavioural tests of fearfulness for quail: a critical evaluation // Applied Animal Behaviour Science. 2005. Vol. 92, Iss. 1—2. P. 113—127.
70. Moss J. The prevalence and phenomenology of repetitive behavior in genetic syndromes / J. Moss, C. Oliver, K. Arron, C. Burbidge, K. Berg // Journal of Autism and Developmental Disorders. 2009. Vol. 39, Iss. 4. P. 572—588.
71. Munkvad I., Pakkerberg H., Randrup A. Aminergic systems in basal ganglia associated with stereotyped hyperactive behavior and catalepsy // Brain Behavior and Evolution. 1968. Vol. 1, Iss. 2, P. 89—100.
72. Murdoch H. Stereotyped behaviors in deaf and hard of hearing children // American Annals of the Deaf. 1996. Vol. 141, Iss. 5. P. 379—386.
73. Neidert P.L. Prevalence and Functions of Self-injurious Behavior in the Prader-Willi Syndrome: Doctoral dissertation / University of Florida. 2007. 62 p.
74. Odberg F.O. The influence of cage size and environmental enrichment on the development of stereotypies in bank voles (Clethrionomys glareolus) // Behavioural Processes. 1987. Vol. 14, Iss. 2. P. 155—173.
75. Parsons L.M. Use of implicit motor imagery for visual shape discrimination as revealed by PET / L.M. Parsons, P.T. Fox, J.H. Downs, T. Glass, T.B. Hirsch, C.C. Martin, P.A. Jerabek, J.L. Lancaster // Nature. 1995. Vol. 375. P. 54—58.
76. Pierce K., Courchesne E. Evidence for a cerebellar role in reduced exploration and stereotyped behavior in autism // Biological Psychiatry. 2001. Vol. 49, Iss. 8. P. 655—664.
77. Randrup A., Munkvad I. Stereotyped activities produced by amphetamine in several animal species and man // Psychopharmacologia Berlin. 1967. Vol. 11. P. 300—310.
78. Richman D.M. Annotation: Early intervention and prevention of self-injurious behaviour exhibited by young children with developmental disabilities // Journal of Intellectual Disability Research. 2008. Vol. 52, Iss. 1. P. 3—17.
79. Rincover A. Sensory extinction and sensory reinforcement principles for programming multiple adaptive behavior change / A. Rincover, R. Cook, A. Peoples, D. Packard // J Appl Behav Anal. 1979. Vol. 12, Iss. 2. P. 221—233.
80. Rincover A., Newsom C.D., Carr E.G. Using sensory extinction procedures in the treatment of compulsivelike behavior of developmentally disabled children // Journal of Consulting and Clinical Psychology. 1979. Vol. 47, Iss. 4. P. 695—701.
81. Robey K.L. Modes and patterns of self-mutilation in persons with Lesch-Nyhan disease / K.L. Robey, J.F. Reck, K.D. Giacomini, G. Barabas, G.E. Eddey // Developmental Medicine & Child Neurology. 2003. Vol. 45, Iss. 3. P. 167—171.
82. Roebel A.M., MacLean W.E.Jr. Spontaneous eye-blinking and stereotyped behavior in older persons with mental retardation // Research in developmental disabilities. 2007. Vol. 28, Iss. 1. P. 37—42.
83. Rogers J.S., Newhart-Larson S. Characteristics of infantile autism in five children with Leber's Congenital Amaurosis // Developmental Medicine & Child Neurology. 1989. Vol. 31, Iss. 5. P. 598—608.
84. Rojahn J., Sisson A.L. Stereotyped behavior // Handbook of behavior modification with the mentally retarded. 2nd ed. / J.L. Matson (Ed.). New York: Plenum Press. 1990, P. 181—223.
85. Rosenberg D.R. Responseinhibition deficits in obsessive-compulsive disorder: an indicator of dysfunction in frontostriatal circuits / D.R. Rosenberg, E.L. Dick, K.M. O'Hearn, J.A. Sweeney // Journal of Psychiatry and Neuroscience. 1997. Vol. 22, Iss. 1. P. 29—38.
86. Rubenstein J.L.R., Merzenich M.M. Model of autism: increased ratio of excitation/inhibition in key neural systems // Genes, Brain and Behavior. 2003. Vol. 2, Iss. 5. P. 255—267.
87. Sallustro F., Atwell C.W. Body rocking, head banging, and head rolling in normal children // The Journal of pediatrics. 1978. Vol. 93, Iss. 4. P. 704—708.
88. Sato S. Stereotyped stepping associated with lesions in the bilateral medial frontoparietal cortices / S. Sato, T. Hashimoto, A. Nakamura, S. Ikeda // Neurology. 2001. Vol. 57, Iss. 4. P. 711—713.
89. Schopler E. Parent survival manual. New York: Plenum Press, 1995.
90. Schroeder S., Rojahn J., Oldenquist A. Treatment of destructive behaviors among people with mental retardation and developmental disabilities: overview of the problem // Treatment of Destructive Behaviors in Persons with Developmental Disabilities. NIH publication No. 91—2410 / U. S. Department of Health and Human Services. Washington, DC, 1991. P. 173—220.
91. Schwartz S.S., Gallagher R.J., Berkson G. Normal repetitive and abnormal stereotyped behavior of nonretarded infants and young mentally retarded children // American Journal of Mental Deficiency. 1986. Vol. 90, Iss. 6. P. 625—630.
92. Singer H.S. Motor stereotypies // Seminars in Pediatric Neurology. 2009. Vol. 16, Iss. 2. P. 77—81.
93. Steele A.L., Jorgenson H.A. Music therapy: an effective solution to problems in related disciplines // Journal of Music Therapy. 1971. Vol. 8, Iss. 4. P. 131—145.
94. Stone A.A. Consiousness: altered levels in blind retarded children. // Psychosomatic Medicine. 1964. Vol. 26, Iss. 1. P. 14—19.
95. Summers J.A. Behaviour problems in Angelman syndrome / J.A. Summers, D.B. Allison, P.S. Lynch, L. Sandler // Journal of Intellectual Disability Research. 1995. Vol. 39, Iss. 2. P. 97—106.
96. Tan A., Salgado M., Fahn S. The characterization and outcome of stereotypical movements in nonautistic children // Movement disorders. 1997. Vol. 12, Iss. 1. P. 47—52.
97. Temudo T. Stereotypies in Rett syndrome Analysis of 83 patients with and without detected MECP2 mutations / T. Temudo, P. Oliveira, M. Santos, K. Dias, J. Vieira, A. Moreira, P. Maciel // Neurology. 2007. Vol. 68, Iss. 15. P. 1183—1187.
98. Thelen E. Rhythmical stereotypies in normal human infants // Animal Behaviour. 1979. Vol. 27. P. 699—715.
99. Toates F.M. Exploration as a motivational and learning system: a cognitive incentive view // Exploration in Animals and Humans / Archer J. and Birke L. (eds). Wokingham, UK: Van Nostrand Reinhold. 1983. P. 55—71.
100. Troster H., Brambring M., Beelmann A. Prevalence and situational causes of stereotyped behaviors in blind infants and preschoolers // Journal of Abnormal Child Psychology. 1991. Vol. 19, Iss. 5. P. 569—590.
101. Volpe J. Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis // Semin Pediatr Neurol. 1998. Vol. 5, Iss. 5. P. 135—151.
102. Walter S., Kuschinsky K. Conditioning of morphine-induced locomotor activity and stereotyped behaviour in rats // Journal of Neural Transmission: General Section JNT. 1989. Vol. 78, Iss. 3. P. 231—247.
103. Warren S.A., Burns N.R. Crib confinement as a factor in repetitive and stereotyped behavior in retardates // Mental Retardation. 1970. Vol. 8, Iss. 3. P. 25—28.
104. Wing L., Wing J.K. (Eds.). Early childhood autism: Clinical, educational, and social aspects. Oxford; New York: Pergamon Press. 1976. 342 p.
105. Yasuda Y. Paramedian thalamic and midbrain infarcts associated with palilalia / Y. Yasuda, I. Akiguchi, M. Ino, H. Nabatabe, M. Kameyama // Journal of neurology, neurosurgery, and psychiatry. 1990. Vol. 53, Iss. 9. P. 797—799.