Predicting the persistence of severe self-injurious behavior.

Meuret et al. (2001) tracked 71 people with intellectual disability who had severe self-injury. They watched who still hurt themselves seven years later. They tested three simple flags: head-directed hits, steady high rate, and younger age.

No treatment was given. The team only scored if the severe self-injury stayed or left.

After seven years, 71% of the group still showed severe self-injury. The three flags guessed this outcome right 76% of the time.

Head hits, unchanging baseline, and early age together spelled long-lasting risk.

Hamilton et al. (1978) showed restraint can stop self-injury fast. Their quick fix makes the 2001 long-range warning feel like bad news. The gap tells you: act hard early, because some cases will stay.

Rajaraman et al. (2022) gave kids choices and wiped out dangerous behavior. Their 2022 success updates the 2001 forecast. Even if the flags say "persistent," new choice-based plans can still turn the tide.

Taylor et al. (1993) found different self-injury forms can serve different functions. The 2001 focus on head-directed hits fits this idea: one shape may signal stronger biological lock-in, so treat that shape with extra force.

You can run the three-flag check today. If a client hits their head, keeps a steady high rate, and is young, plan for the long haul. Stack early, dense interventions and monitor for years, not weeks.