Self-injurious behaviour before and after deinstitutionalization.
After leaving institutions, adults with ID who cannot walk or have seizures are the most likely to start self-injury—watch them first.
01Research in Context
What this study did
The team followed the adults with intellectual disability for two years. All had just moved from large state hospitals into small community homes.
Staff recorded any new self-injury such as head-hitting or hand-biting. The researchers also noted each person’s mobility, seizures, and caretaker turnover.
What they found
About one in six people began serious self-injury after the move. Risk was highest for those who could not walk, had daily seizures, or scored very low on developmental tests.
Frequent staff changes also raised risk a little, but the link was weak. Overall, the picture stayed messy; no single factor clearly predicted who would get hurt.
How this fits with other research
Lord et al. (1997) saw more behavior problems in non-verbal clients. Cullinan et al. (2001) agrees: the clients who later hurt themselves had the lowest developmental scores.
Borrero et al. (2005) showed you can stop existing self-injury by giving a favorite pillow nonstop. Their study looks opposite, but it tests treatment, not prediction. Same behavior, different question.
Repp et al. (1992) tracked daytime bladder gains over seven years in the same kind of homes. Like Cullinan et al. (2001), they found tiny, slow changes and no magic predictor. Both warn: progress is gradual.
Why it matters
If you serve adults moving into group homes, flag the non-ambulatory clients with seizures first. Watch them weekly, not monthly. Start communication or sensory tools early; Borrero et al. (2005) shows these can work later. Document tiny gains, because big jumps are rare.
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02At a glance
03Original abstract
The deinstitutionalization movement is presently spreading in Europe. Studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) have been inconclusive. The present paper focuses on people without self-injurious behaviour (SIB) who developed SIB after deinstitutionalization. The present authors studied individual and environmental characteristics before and after deinstitutionalization to look for factors associated with the development of SIB which could also be possible intervention points for preventive action. All those individuals in an institution for people with ID who did not have SIB before deinstitutionalization were included in the present study. The individuals who developed SIB after deinstitutionalization (n = 15) formed the study group (group A) and those who did not (n = 53) comprised the control group (group B). The population was examined both before and after deinstitutionalization. As far as possible, the same methods were used at both occasions. The covariates were both individual (e.g. mental health, behaviour disturbances and behaviour deficits) and environmental (e.g. caretaker education, caretaker:patient ratio, housing and leisure activities). Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults, which was filled in by the caretakers. In 1987, the people in group A who acquired SIB had lower developmental quotients, used wheelchairs more often and had trouble with moving around without help. They also had a greater frequency of epileptic seizures, and hearing and communication impairment. In 1995, there were only minor environmental differences between groups A and B. There were significantly more individuals involved in the rotation period and more unskilled caretakers working with the people in group A than group B. The present authors found no differences between the two groups on variables such as global mental health and behaviour disturbances, or in the use of neuroleptics before or after deinstitutionalization. Groups A and B did not show differences in behaviour disturbances or psychiatric disorders in 1987. In both 1987 and 1995, there were no differences between groups A and B on variables such as accommodation, caretaker:patient ratio, the number of caretakers involved in direct care, the caretakers' education, or the time spent in structured activities before and after deinstitutionalization. The individual characteristics indicating that a person may acquire SIB are behaviour deficits which are suggestive of central nervous system dysfunction or damage, even if the results are inconclusive. The development of SIB may also be facilitated by communication deficits or by reinforcement of a incidentally occurring SIB if the staff includes many unskilled caretakers in the rotation period.
Journal of intellectual disability research : JIDR, 2001 · doi:10.1046/j.1365-2788.2001.00332.x