Self-Injury, Aggression & Destruction in Children with Severe Intellectual Disability: Incidence, Persistence & Novel, Predictive Behavioural Risk Markers

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.

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By:  Davies LE1, Oliver C2.

• 1Finch Road Primary Care Centre, Finch Road, Lozells, Birmingham B19 1HS, UK.
• 2Cerebra Centre, University of Birmingham (http://www.birmingham.ac.uk/schools/psychology/centres/cerebra/index.aspx), Edgbaston, Birmingham B15 2TT, UK. Electronic address: c.oliver@bham.ac.uk. 

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What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis

Background

Young people with complex or severe mental health needs sometimes require care and treatment in inpatient settings. There are risks for young people in this care context, and this study addressed the question: ‘What is known about the identification, assessment and management of risk in young people (aged 11–18) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?’

Methods

In phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO) was undertaken. Items included were themed and presented to members of a stakeholder advisory group, who were asked to help prioritise the focus for phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and Web of Science) were searched. Websites were explored and a call for evidence was circulated to locate items related to the risks to young people in mental health hospitals relating to ‘dislocation’ and ‘contagion’. All types of evidence including research, policies and service and practice responses relating to outcomes, views and experiences, costs and cost-effectiveness were considered. Materials identified were narratively synthesised.

Results

In phase 1, 4539 citations were found and 124 items included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing the risks of ‘dislocation’ and ‘contagion’ were included supplemented by 20 policy and guidance documents. The quality of studies varied. Materials were synthesised using the categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis. Although we found evidence of consideration of risk to young people in these areas we found little evidence to improve practice and services.

Conclusions

The importance to stakeholders of the risks of ‘dislocation’ and ‘contagion’ contrasted with the limited quantity and quality of evidence to inform policy, services and practice. The risks of dislocation and contagion are important, but new research is needed to inform how staff might identify, assess and manage them.

Below:  Phase 1 themes

Full article at:  http://goo.gl/txXwYG

By:   Deborah Edwards¹, Nicola Evans¹, Elizabeth Gillen², Mirella Longo³, Steven Pryjmachuk⁴,Gemma Trainor⁵ and Ben Hannigan^1*

¹School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK

²Information Services, Cardiff University, Cardiff, UK

³College of Human and Health Sciences, Swansea University, Swansea, UK

⁴School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

⁵Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK

 

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Harm to Others from Substance Use and Abuse: The Underused Potential in Nationwide Registers

This article considers the potential in using nationwide registers to study harm to others from substance use and abuse. The advantages of using registry data include the opportunity to include the data on the entire population nationwide and continuously updated longitudinal datasets; they allow for studying small subpopulations and have little missing data. Personal identification numbers and family numbers enable linkage of data from different registers. Such datasets can include extensive information on individual and family levels. In this article, we provide an introduction to nationwide registers and explain how they can be applied to investigate two types of third-party harms: harm to children and harm to partners/spouses from substance use and abuse in parents and partners/spouses. Finally, we discuss challenges, benefits, and ethical considerations regarding the use of such data.

Substance use and abuse contribute not only to harm to the user but also to third parties. Current estimates of the prevalence and extent of harm to others from substance use and abuse may be unreliable partly because persons with substance use problems are less likely to respond to surveys.¹ Nationwide registers provide a unique opportunity to study harm to others from substance use and abuse that can contribute to more reliable estimates of the prevalence and extent of such harms. Registry data enable studying the entire populations for long periods of time; they often include large samples and are therefore well suited to study small patient groups and rare outcomes. Despite these advantages, registry data are rarely used to study harm to others from substance use and abuse. We aim to provide information that make more researchers aware of the possibilities with registry data, alone or in combination with survey data, to answer research questions on this topic in both clinical and general populations. We describe relevant registers and how they can be applied to investigate two types of third-party harm: (1) harm to children from in utero exposure to substances^2,3 and from growing up with parents who use or abuse legal and/or illegal substances^4,5 and (2) harm to spouses/partners. We also discuss challenges, benefits, and ethical considerations regarding the use of such data. It is beyond the scope of this article to cover how all registers available across countries can be used to study harm to others from substance use and abuse. Instead, we use the Norwegian setting as an example of how nationwide registers can be applied to address such research questions. However, we also refer to examples from other countries….

Full article at:  http://goo.gl/CTwAKp

By:  Lund IO1, Bukten A2.

• 1The Norwegian Institute of Alcohol and Drug Research (SIRUS), Oslo, Norway.
• 2Norwegian Centre for Addiction Research, Oslo, Norway. 

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