Aggressive and self-injurious behaviour : towards a community early intervention strategy

In order to provide early intervention services for aggressive and self-injurious behaviour to a total population of children with intellectual disabilities, a community strategy must be developed, to complement programmes within specialist schools, services and support groups. Within this thesis a number of important elements of a community early intervention strategy were explored. A recruitment strategy based within community child health services was trialled. Within the community cohort of children identified specific putative risk markers for aggressive and self-injurious behaviour were examined, indicating several suitable candidates for screening. A more in depth examination of this community cohort highlighted a complex psychological profile, with high levels of Autism Spectrum Disorder and Attention Deficit/ Hyperactivity Disorder type characteristics. An assessment protocol based on traditional functional analytic methods was also trialled within a sub-group of high risk children. Whilst a useful starting point was identified for the majority of children, serious barriers to recruitment were identified, and a more comprehensive assessment protocol is required. High levels of parental anxiety and depression symptoms, associated with avoidant coping strategies and negative views about child behaviour, were also reported. The results presented within this thesis have important implications for the development of a community early intervention pathway. Specific considerations relating to screening, recruitment, assessment and family context are necessary when implementing early intervention within a community cohort of children.