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The research was approved by the institutional review board.

Permission was obtained from the author of ISAS to use his tool and to translate it. Informed consent was also obtained from the heads of the schools, and teachers as well as from the parents of the participants. Results Of the children, Table-2 When neural network model was run on the total data set, the most important predictor of NSSI was type of disability 0. However, counselling access 0. For the participants with hearing loss the most important predictor was the level of disability 0.

Similarly, the level of disability appeared to be the most important predictor of NSSI among the participants with ID 0. On the other hand, training and education 0. However, the results indicated that age and gender were playing minimum roles in developing NSSI among the participants with disabilities.

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Self-Directed Violence and Other Forms of Self-Injury

Percentages of scores obtained on the ISAS revealed higher prevalence of NSSI among participants with intellectual disability as compared to their counterparts with hearing loss. These results are consistent with the previous study which indicated high prevalence of self-injurious behaviour in intellectually disabled children. The results of present study also indicated that NSSI is more prevalent in the participants having severe and profound levels of disabilities as compared to the children with mild and moderate levels.

Further level of self-injury is higher among the children who belong to lower education and training levels. The children with hearing loss studies in grades like children without hearing loss, but the children with intellectual disabilities are divided in training level 1 and 2 and above according to their intellectual capabilities.

At training level 1 the children are taught self-help skills. Therefore, the results of present study indicate that NSSI prevails at lower level among the children as compared to the participants who are at higher levels of education and training. It also found high prevalence of NSSI among the boys of both groups. A plausible reason is their lack of awareness, knowledge and adjustment to many physical and hormonal changes between the ages of 12 to 18 years. All of the above-mentioned findings are further supported by the results of neural network.

Disability itself is undoubtedly the main cause of restricted cognitive and social functioning of the participants and puts them at the risk of maladjustment. This leads towards the use of negative coping strategies by them. However, we cannot ignore the importance of associated factors such as education and training as well as access to counselling.

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Previous studies concluded that education, training programme, interventions and counselling reduce the self-harm behaviour in children with disabilities. In addition, the degree of disability predicted the self-injurious behaviour in children with disabilities when neural network run on the split file on the basis of disability.

Here again, the education and training as well as access to counselling service have been the second- and third-most important factors to predict NSSI among the participants. The results of neural network on the separate data files of participants with hearing loss and intellectual disabilities showed the levels of disability as the most important predictor of self-injurious behaviour among the participants. The literature showed that severity of disability is associated with self-injurious behaviour among intellectually disabled children.

These poor skills lead towards poor interpersonal relationships of the individuals with disabilities in their homes, schools and at other social places because they cannot express their needs and emotions properly, and as a result they cannot be understood by others.


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This lack of understanding further leads towards improper fulfilment of their unique needs which triggers frustration in the individuals with disabilities. This frustration may be minimised with the help of education and training programme which further reduces NSSI.

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In addition, the emotional and cognitive skills possessed by young people themselves can help them to manage adversity more effectively, without engaging in self-harming or suicidal behaviour. Problem solving skills such as self-control, self-efficacy and positive future thinking can be protective.

Education and training as well as access to counselling services are also playing an important role in predicting NSSI among participants because these programmes improve the awareness, knowledge and adaptive social skills of the participants. Moreover, these programmes improve coping strategies among the individuals. The current study had a few limitations as well.

For instance, it presented preliminary information on NSSI among the children with two types of disability residing in 3 cities only.


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  5. The sample could not be calculated according to all study variables. Further in-depth research on a larger scale focusing and exploring the factors associated to NSSI is needed. Conclusion The prevalence of NSSI among children with intellectual disability was higher as compared to those with hearing loss. The results of neural network support these findings. It is revealed that disability itself and the associated factors like the degree of the disability, access to counselling services and education and training are the most important predictors of self-injury among the participants.

    In order to prevent, reduce and manage NSSI among the children with disabilities, awareness and training programmes should be introduced in educational institutes for children, parents and teachers. Moreover, the children with disabilities must have access to counselling services, particularly in their adolescence which is the time period that is characterised by physical and hormonal changes. Disclaimer: None. Conflict of Interest: None.


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    Source of Funding: None. References 1. Self-injurious implicit attitudes among adolescent suicide attempters versus those engaged in nonsuicidal self-injury. J Child Psychol Psychiatry ; Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles. Clin Psychol Rev ; Prospective prediction of nonsuicidal self-injury: A 1-year longitudinal study in young adults.

    Behav Ther ; Nonsuicidal self-injury: A review of current research for family medicine and primary care physicians. J Am Board Fam Med ; Correlates of self-injurious, aggressive and destructive behaviour in children under five who are at risk of developmental delay, Res Dev Disabil ; Fudamentals of special education:what every teacher needs to know.

    Pearson Education Inc. New Jersey, USA: Zhu L. Disability Research. Davies L, Oliver C. The age related prevalence of aggression and self-injury in persons with an intellectual disability: A review. Res Dev Disabil ; Oliver C, Richards C. Self-injurious behaviour in people with intellectual disability.

    Decreasing Self Injurious Behaviors

    Curr Opin Psychiatry ; Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder. Autism ; While it may not be an option to ignore SIBs that can cause serious harm, when it is necessary to stop an SIB, intervene as neutrally as possible to keep the individual safe and discontinue attention once the individual is no longer at risk. Additionally, reinforcing other behavior that makes the SIB impossible may be beneficial for example, reinforcing the individual for doing an activity with his or her hands, which keeps the hands occupied and prevents slapping.

    Sometimes, a doctor may recommend treating your child with medication to control SIBs. However, all medications have risks of side effects, and in some individuals, a medication may actually increase SIBs. You and your doctor should discuss whether medication is a good option for your family. Sometimes, despite best efforts, SIBs continue to occur for seemingly no reason.

    Self-injury in patients with intellectual disability : Nursing

    Your first priority is to keep your child safe. Some families resort to the use of restraints or protective headgear; others seek in-patient help for their child. These decisions are difficult ones to make and should be made with the advice of trusted therapists and doctors. Make sure you considering counseling for yourself as well.

    SIBs can be very stressful on a family, and you may find it helpful to process your emotions with a professional counselor. Respite for the family may also be beneficial, however families may be hesitant to access respite for fear that respite will not provide adequate care in case a SIB occurs. Building a strong support network can be invaluable to these parents, who often feel isolated and helpless. Self-Injurious Behavior. The Center for Autism Research and The Children's Hospital of Philadelphia do not endorse or recommend any specific person or organization or form of treatment.