Clinical utility of risk markers for aggression and destruction in children with intellectual disability

Rationale: Since the previous synthesis of data pertaining to risk markers for individual behaviours that challenge (McClintock et al., 2003), there has been an additional wealth of research, however no additional synthesis. A comprehensive understanding of risk markers for self-injury, aggression and destruction in people with intellectual disabilities has the potential to facilitate the development of strategies to identify at-risk individuals earlier and devise more well-informed interventions. Method: A meta-analysis was conducted incorporating the data from the previous meta-analysis ranging from 1968 to 2002 (McClintock et al., 2003), as well as additional data published between 2002 and 2018, totalling 60 papers. Results: Results indicated that level of intellectual disability and presence of autism was significant risk markers for all three behaviours. Additional risk markers for self-injury included: fragile X syndrome, increased repetitive behaviour, Cornelia de Lange syndrome, residing in paid care, tuberous sclerosis complex, visual deficit, expressive communication deficit, Prader Willi syndrome, Angelman syndrome, overactivity, hearing deficit, mobility deficit, adaptive behaviour deficit, epilepsy and female gender. Down syndrome represented decreased risk for self-injury and aggression. Additional risk markers for aggression included: living in paid care, epilepsy, expressive communication deficit and Smith Magenis syndrome. Conclusion: This meta-analysis highlights that data pertaining to self-injury is far more comprehensive than for aggression or destruction. It emphasises the need for additional research within these areas, as well as within specific syndromes. As advancements are made in understanding risk markers for specific behaviours, these may be used to inform interventions or earlier identification of individuals at particularly increased risk