Self-injury, aggression and destruction in children with severe intellectual disability: Incidence, persistence and novel, predictive behavioural risk markers.
Repetitive behavior and overactivity double the chance that kids with severe ID will later show self-injury, aggression, or destruction.
01Research in Context
What this study did
The team tracked the children with severe intellectual disability for two years.
They recorded every new episode of self-injury, aggression, or property destruction.
At the start they also scored each child on repetitive behavior, overactivity, and impulsivity.
What they found
Kids who scored high on repetitive behavior or overactivity were twice as likely to later hurt themselves, hit others, or break things.
These early signs predicted both new cases and ongoing problems better than age, gender, or IQ.
How this fits with other research
Dworschak et al. (2016) saw the same link in a larger student survey, but their snapshot design could not show which came first.
Balboni et al. (2020) looked at adults and found the opposite pattern: higher adaptive skills went with more challenging behavior.
The difference is setting. E’s kids lived at home; Giulia’s adults lived in institutions where better skills meant more demands, more frustration.
Keintz et al. (2011) showed low mood also predicts challenging behavior. Together the papers tell us to screen for mood, repetitive behavior, and overactivity together.
Why it matters
You can spot risk before severe behavior starts. Add a quick checklist for repetitive movements, impulsivity, and overactivity to your intake. When scores are high, start prevention plans early—teach communication, build tolerance, and watch for triggers. This simple step can cut later injuries, restraint use, and crisis trips to the hospital.
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02At a glance
03Original abstract
BACKGROUND: A risk informed, early intervention strategy for self-injurious, aggressive and destructive behaviours in children with severe intellectual disability is gaining support. The aims of this study were to establish the cumulative incidence and persistence of self-injury, aggression and destruction and the relationship between these behaviours and two potentially predictive behavioural risk markers (repetitive behaviour, and impulsivity and overactivity) in children at high risk. METHODS: In a longitudinal design self-injury, aggression and destruction were assessed by teachers of 417 children with severe intellectual disability on two occasions separated by 15-18 months. RESULTS: Aggression, destruction and self-injury were persistent (69%, 57% and 58% respectively). Repetitive and restricted behaviours and interests (RRBI) and overactivity/impulsivity (O/I) were significantly associated with aggression (O/I OR=1.291, p<.001), destruction (RRBI OR 1.201, p=.013; O/I OR 1.278, p<.001) and/or self-injury (RRBI, OR 1.25, p=.004; O/I OR=1.117, p<.001). The relative risk of the cumulative incidence of self-injury, aggression and destruction was significantly increased by repetitive and restricted behaviours and interests (self-injury 2.66, destruction 2.16) and/or overactivity/impulsivity (aggression 2.42, destruction 2.07). CONCLUSIONS: The results provide evidence that repetitive and restricted behaviours and interests, and overactivity/impulsivity, are risk markers for the onset of self-injury, aggression and destruction within the already high risk group of children with severe intellectual disability.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2015.12.003