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. Scope 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. Findings 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.