title: Self-injury, aggression and destruction in children with severe intellectual disability: Incidence, persistence and novel, predictive behavioural risk markers.
abstract: BACKGROUND
  A risk informed, early intervention strategy for self-injurious, aggressive and destructive behaviours in children with severe intellectual disability is gaining support. The aims of this study were to establish the cumulative incidence and persistence of self-injury, aggression and destruction and the relationship between these behaviours and two potentially predictive behavioural risk markers (repetitive behaviour, and impulsivity and overactivity) in children at high risk.
  
  
  METHODS
  In a longitudinal design self-injury, aggression and destruction were assessed by teachers of 417 children with severe intellectual disability on two occasions separated by 15-18 months.
  
  
  RESULTS
  Aggression, destruction and self-injury were persistent (69%, 57% and 58% respectively). Repetitive and restricted behaviours and interests (RRBI) and overactivity/impulsivity (O/I) were significantly associated with aggression (O/I OR=1.291, p<.001), destruction (RRBI OR 1.201, p=.013; O/I OR 1.278, p<.001) and/or self-injury (RRBI, OR 1.25, p=.004; O/I OR=1.117, p<.001). The relative risk of the cumulative incidence of self-injury, aggression and destruction was significantly increased by repetitive and restricted behaviours and interests (self-injury 2.66, destruction 2.16) and/or overactivity/impulsivity (aggression 2.42, destruction 2.07).
  
  
  CONCLUSIONS
  The results provide evidence that repetitive and restricted behaviours and interests, and overactivity/impulsivity, are risk markers for the onset of self-injury, aggression and destruction within the already high risk group of children with severe intellectual disability.
authors.affiliation: Finch Road Primary Care Centre, Finch Road, Lozells, Birmingham B19 1HS, UK.
authors.forename: L E
authors.initials: LE
authors.lastname: Davies
authors.affiliation: Cerebra Centre, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Electronic address: c.oliver@bham.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Oliver
mesh_terms: D000374:Aggression / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D015994:Incidence; D008607:Intellectual Disability / Q000453:epidemiology* / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D000066553:Problem Behavior / Q000523:psychology*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology
keywords: Aggression; Challenging behaviour; Destruction; Self-injury; Severe intellectual disability