Transvestism in a person with learning disabilities presenting with behavioural problems.

A man with intellectual disability moved from hospital to group home. Staff saw he wore women’s clothes right before he hit people.

Doctors wrote a one-person case study. They paired the cross-dressing with aggression and built a behavior plan. No numbers were kept.

The team showed that dressing in women’s clothes worked like a warning light. When the clothes went on, hitting usually followed.

By treating both acts together, staff could step in early. The paper gives no scorecard, so we do not know how much the hitting dropped.

Firth et al. (2001) watched the adults with ID in the same kind of home. They saw that caregivers most often gave attention right after aggression. The 1995 case adds a new signal—cross-dressing—that can tell staff when that attention is about to be needed.

Lejuez et al. (2001) used a timer-based reward plan to cut low-rate, high-intensity aggression. Their plan and the 1995 plan both aim at rare but serious hits, yet W used strict DRO while R used a custom sex-linked cue. The ideas sit side-by-side, not against each other.

Matson et al. (2008) reviewed lots of single-case reports on self-injury in autism and ID. Our 1995 study is the sort of paper they would have shelved under “needs more data.” Taken together, the message is clear: tailor the plan, then measure it.

If you serve adults with ID and sudden aggression, watch for private warning signs like clothing choices. Map the chain, teach a safe replacement, and track counts. One extra minute of data beats a stack of notes without numbers.