The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district.
Aggression in learning disability services is common but rarely dangerous, so target your safety resources to the a large share who pose real injury risk.
01Research in Context
What this study did
A UK health team counted every person with learning disabilities in one district.
They asked carers if each person hit, kicked, bit, or threw things in the last month.
The final head-count was the adults and children living at home, in hospitals, or in day centers.
What they found
Seventeen out of every 100 people showed some form of aggression.
Hospital residents had the highest rate: 38 in 100.
Day-center users had the lowest: 10 in 100.
Only 7 people—less than a large share—hurt someone badly enough to need medical care.
How this fits with other research
Allison et al. (1980) showed that, for two children, aggression worked like a “let me out” button. When demands stopped after they hit, hitting stayed strong. Leung (1993) now tells us how often that button gets pressed across a whole region.
Chen et al. (2017) looked at preschoolers with autism and found lower overall aggression than typical kids. Leung (1993) found the opposite—higher rates than the general public—but studied older people with learning disabilities, not preschoolers with autism. The two surveys together say: diagnosis, age, and setting all move the numbers.
Raslear et al. (1992) noted that up to a large share of girls with Rett syndrome use challenging behavior to communicate. Leung (1993) adds a head-count showing most aggression in this population is mild and rare, reminding us to look for the message behind the hit.
Why it matters
Use these base rates when you size up risk. If only 1 in 100 clients is likely to cause serious harm, you can reserve the costliest safety plans for the few who need them. Spend the saved hours on teaching communication or tolerance skills—the functions Allison et al. (1980) first mapped out.
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02At a glance
03Original abstract
This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370,000. At the time of the survey, the Mental Handicap Register for the district recorded 1,362 people as having a learning difficulty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7%) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difficulties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reported behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self-injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difficulties from the district were reported to be currently presenting such a risk. Similarly, only 2% of the base population (n = 18) were reported to be extremely difficult to manage. The implications of the findings are discussed.
Journal of intellectual disability research : JIDR, 1993 · doi:10.1111/j.1365-2788.1993.tb01281.x