Practitioner Review: Self-injurious behaviour in children with developmental delay.
BACKGROUND
Self-injurious behaviour is shown by a significant minority of children with developmental delay and has a substantial impact on child and carer wellbeing. Characteristics such as a greater degree of intellectual disability, autism spectrum disorder, some genetic syndromes and repetitive and impulsive behaviours are positively associated with self-injury. Prevalence generally increases with age into midadulthood and the behaviour is notably persistent.


METHODS
In this review, we discuss the dominant causal theory of self-injury which draws on the principles of operant learning. We evaluate the utility of this theory to account for all empirical observations of self-injury.


RESULTS
A model of self-injury is presented that extends a previous model described by Guess and Carr. The new model integrates child characteristics and operant learning principles in a phenotype × environment paradigm to explain the variance in developmental trajectory of the severity of self-injury.


CONCLUSIONS
Behaviour dysregulation, as evidenced by the associations between self-injury, self-restraint, repetitive and impulsive behaviours, is identified as potentially influencing the severity and persistence of self-injury. Risk markers for self-injury are identified and the extended model indicates points of intervention and highlights the possibility of risk-related, targeted early intervention. The need for increased training of practitioners in the delivery of demonstrably effective interventions for self-injury is identified.
Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, UK.
Chris
C
Oliver
Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Edgbaston, UK.
Caroline
C
Richards
D000067877:Autism Spectrum Disorder / Q000150:complications / Q000503:physiopathology*; D002648:Child; D003216:Conditioning, Operant / Q000502:physiology*; D002658:Developmental Disabilities / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008607:Intellectual Disability / Q000150:complications / Q000503:physiopathology*; D016728:Self-Injurious Behavior / Q000209:etiology / Q000503:physiopathology*
Self-injury; applied behaviour analysis; autism spectrum disorder; behaviour dysregulation; behavioural phenotype; genetic syndrome; intellectual disability