A survey of self-restraint, self-injury, and other maladaptive behaviors in an institutionalized retarded population.

Staff at one large residential center filled out checklists about every client. They noted who wrapped arms in clothes, held objects tight, or used other self-restraint. They also recorded who hit, bit, or scratched themselves.

The survey covered the whole census. No one tried to change behavior. The goal was to see how often self-restraint and self-injury show up together.

Almost every person who self-restrained also hurt themselves. In the general school wing, fewer clients showed self-injury. In the self-restraining group, self-injury was the norm, not the exception.

The pattern hinted that wrapping or holding might be a way to keep hurting under control.

Leung et al. (2011) later asked the same question across seven genetic syndromes. They found very different SIB rates, but still saw the tight link between restraint and injury. The 1989 snapshot now looks like the broad base of that finer picture.

Pitchford et al. (2019) reviewed newer treatment studies and saw more automatically maintained SIB than in the old days. Fovel et al. (1989) did not test function, yet their co-occurrence data foreshadowed that automatic reinforcement would turn out to be common.

Davies et al. (2014) warned not to treat SIB as a sign of depression in ID. Fovel et al. (1989) never claimed it was; they simply counted the acts. Together, the two papers push clinicians to look at behavioral context, not mood labels.

When you see a client wrapping a jacket around their arms, think "possible self-injury ahead." Use that moment to scan for early hits or bites. Add brief physical prompts to teach safer self-hugging or squeeze tools. The restraint itself is not the problem; it is a red flag that self-injury is likely part of the same response class.