Predictors for attacks on people after deinstitutionalization.
Self-injury plus low PIMRA soundness flags adults who may start hitting others soon after leaving institutional care.
01Research in Context
What this study did
Nøttestad et al. (2002) followed adults with intellectual disability who were moving out of institutions. They wanted to know who would start hitting, kicking, or biting people after the move.
The team looked at old records, gave the PIMRA psychiatric screen, and tracked new aggression for one year.
What they found
Clients who already hurt themselves and those who scored low on PIMRA “soundness” were the most likely to begin aggressive acts later. General behavior problems also raised risk.
No single factor gave a clear green-light for extra help; the signs pointed to a group, not to named individuals.
How this fits with other research
Cashon et al. (2013) saw the same red flags—early aggression and poor coping—inside long-term inpatient units. Their work extends Aa’s by showing the pattern holds even when people do not move.
van der Miesen et al. (2024) meta-analysis proves we can cut self-injury by 90% with caregiver-run plans at home. That matters because Aa found self-injury predicts later aggression; treating SIB before a move may prevent the new aggression entirely.
Rojahn et al. (1994) surveyed 2,412 Queensland residents and found aggression rates drop as soon as people leave institutions. Aa’s study seems to clash—why would aggression rise after a good move? The gap is timing: J measured prevalence across settings, while Aa captured new onset in the stressful first year out.
Why it matters
If a client self-injures or scores low on PIMRA “soundness,” layer extra behavior supports around moving day. Start an SIB intervention first, teach coping skills, and brief new staff on crisis plans. These steps may stop the first punch before it happens.
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02At a glance
03Original abstract
BACKGROUND: The deinstitutionalization movement is presently spreading in Europe, but studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) are inconclusive. The prevalence of aggressive behaviour among people with ID is high in both institutions and in community. Aggression and attacks on people are a significant problem for people with ID in both institutions and society. In the present paper, the authors focus on individuals who started attacking people after deinstitutionalization. METHOD: The authors studied individual and environmental characteristics before and after deinstitutionalization to look for individual and environmental predictors for the development of aggression with the hope that some could be possible intervention points for preventive action. In an institution for people with ID, all who did not attack people before deinstitutionalization were included. The individuals who started attacking others after deinstitutionalization (n = 22) were the study group (group A) and those who did not (n = 42) comprised the control group (group B). The population was examined before and after deinstitutionalization. As far as possible the same methods were used at both occasions. The covariates included individual ones, such as mental health, behaviour disturbances and behaviour deficits, and environmental ones, such as 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 (PIMRA), which was filled in by the caretakers. RESULTS: Group A showed significantly more self-injurious behaviour (SIB) than group B in 1987. The sum of behaviour disturbances shown in the past year, attacks on property, SIB and other disruptive behaviours were also significantly higher in group A than in group B. The soundness scores on the PIMRA for the people in group A were lower than for the people in group B. Group A contained significantly fewer people without behavioural problems in the past year. The authors could not find any differences on other individual characteristics such as aetiologies of ID and behaviour deficits in 1987. The caretakers' evaluations of the clients need for help, based on behaviour disturbances and mental health problems, were significantly higher in group A. The people in this study differed in age, gender and degree of ID from those in most other studies on ID and challenging behaviour. CONCLUSION: The individual predictors for starting to attack others after deinstitutionalization were SIB, a slight load of other behaviour problems and a low soundness score on the PIMRA. The only environmental predictor was the caretakers' evaluation of the subjects' need for help caused by behaviour problems and mental illness. The authors could not identify possible preventive intervention points, neither individual or environmental, and therefore, further studies are needed.
Journal of intellectual disability research : JIDR, 2002 · doi:10.1046/j.1365-2788.2002.00418.x