Predictors of Self-Injurious Behavior and Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control.

Richards et al. (2017) sent surveys to 424 families of people with autism. They asked about self-hitting, self-biting, and self-restraint. They also asked about health pain, activity level, and daily-living skills.

The team wanted to know which mix of traits best explains why some individuals hurt themselves while others do not.

Severe self-injury showed up most often when three things overlapped: low ability, painful health issues, and high overactivity or impulsivity. Self-restraint—like wrapping arms in clothes—was also common and rose with the same three factors.

The pattern points to a single story: when the body hurts and brakes on behavior are weak, self-harm becomes the outlet.

Koegel et al. (2014) saw the same link in toddlers with delay. Overactive and impulsive toddlers were the ones who later broke toys and furniture. The new study widens the lens: the pattern still holds across the full autism spectrum.

Oliver et al. (2012) found that strong repetitive rituals raised the odds of later self-injury 16-fold in kids with severe ID. Caroline’s team now show the risk stays high in ASD and adds health pain as a second fuel source.

Pitchford et al. (2019) followed toddlers for ten years. Early repetitive behaviors forecast teenage hyperactivity and impulsivity. The 2017 survey lands at the end of that same developmental path—impulsivity plus pain now shows up as self-injury.

During intake, pair your behavior questions with a quick health-pain checklist. Ask about ear infections, GI pain, and dental issues. If the client is overactive and has daily pain, plan both medical follow-up and replacement skills that give sensory feedback without harm. Targeting pain plus impulsivity beats treating self-injury alone.