Self-injurious behaviour before and after deinstitutionalization

Area of Science:

• Intellectual Disability Research
• Behavioral Science
• Public Health Policy

Background:

• The deinstitutionalization movement is expanding across Europe, impacting individuals with intellectual disability (ID).
• Previous research on the effects of deinstitutionalization on behavioral disturbances in ID populations has yielded inconclusive results.
• This study specifically investigates the development of self-injurious behavior (SIB) in individuals with ID who did not exhibit SIB prior to deinstitutionalization.

Purpose of the Study:

• To identify individual and environmental factors associated with the development of self-injurious behavior (SIB) following deinstitutionalization in people with intellectual disability (ID).
• To explore potential intervention points for preventing SIB development.
• To compare individuals who developed SIB post-deinstitutionalization with those who did not.

Main Methods:

• A cohort study design comparing individuals with ID who developed SIB after deinstitutionalization (n=15) to a control group who did not (n=53).
• Assessment of individual characteristics (mental health, behavior disturbances, deficits) and environmental factors (caretaker education, ratios, housing, activities) before and after deinstitutionalization.
• Utilized the Psychopathology Instrument for Mentally Retarded Adults for psychiatric disorder identification in 1987 and 1995.

Main Results:

• Prior to deinstitutionalization (1987), individuals who later developed SIB (Group A) exhibited lower developmental quotients, increased wheelchair use, mobility challenges, more frequent epileptic seizures, and greater hearing/communication impairments compared to controls (Group B).
• Post-deinstitutionalization (1995), environmental differences were minimal, though Group A had more staff rotation and a higher proportion of unskilled caretakers.
• No significant differences were found between groups regarding global mental health, overall behavior disturbances, neuroleptic use, psychiatric disorders, accommodation, caretaker ratios, or structured activity time before or after deinstitutionalization.

Conclusions:

• Individual characteristics, particularly behavior deficits suggestive of central nervous system dysfunction, appear to be key indicators for the potential development of SIB.
• Communication deficits may also contribute to SIB development.
• The presence of numerous unskilled caretakers during staff rotation periods might facilitate the reinforcement of incidentally occurring SIB.