The Prevalence and Correlates of Self-restraint in Individuals with Autism and/or Intellectual Disability:a Systematic Review and Meta-analysis


Purpose: Self-restraint, purposeful restriction of one’s own bodily movements is observed in individuals with neurodevelopmental conditions. Case studies and cross-sectional investigations have reported that self-restraint co-occurs with self-injurious behaviour; however, small sample sizes limit understanding of prevalence and function. We aimed to synthesise the existing literature and estimate the pooled prevalence of self-restraint in autistic individuals and/or individuals with intellectual disability, and the pooled effect size with self-injury. Methods: Six databases were systematically searched in accordance with PRISMA guidelines. Results: A total of 21,567 papers were retrieved, with 15 samples from 13 records included in the analyses. The pooled prevalence estimate of self-restraint in individuals with autism and/or intellectual disability was 39%, 95% CI [26.25, 51.59]. Age and presence of autism significantly increased prevalence rates. Pooled prevalence estimates were consistent across gender, presence of intellectual disability, and type of measurement of self-restraint. Meta-analyses of 31 topographies of self-restraint revealed ‘holds or squeezes objects’ and ‘holding onto others, holding onto others’ clothing’ were the most prevalent behaviours amongst those who self-restrained (both 32%). The least prevalent behaviour was ‘chooses mechanical restraint’ (1%). Pooled prevalence estimates of self-restraint in individuals known to self-injure were 34%, 95% CI [21.36, 46.97], and 13%, 95% CI [5.01, 21.43], in individuals who did not self-injure. Self-restraint and self-injurious behaviour were positively correlated, r = 0.21, 95% CI [0.14, 0.27], K = 13. Conclusions: Findings highlight that on average, over one third of individuals with autism and/or intellectual disability show self-restraint. Clinical and theoretical implications of findings are discussed.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
Additional Information: Copyright © The Author(s), 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
Uncontrolled Keywords: Autism,Intellectual disability,Meta-analysis,Self-injurious behaviour,Self-restraint,Psychiatry and Mental health,Cognitive Neuroscience,Developmental Neuroscience,Behavioral Neuroscience
Data Access Statement: Supplementary information available via publication.
Last Modified: 14 May 2024 16:44
Date Deposited: 11 Apr 2024 13:50
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Related URLs: https://link.sp ... 489-024-00450-5 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Review article
Published Date: 2024-04-05
Published Online Date: 2024-04-05
Accepted Date: 2024-03-19
Authors: Marlow, Katherine
Agar, Georgie (ORCID Profile 0000-0001-8707-8713)
Jones, Christopher
Devine, Rory T.
Richards, Caroline



Version: Published Version

License: Creative Commons Attribution

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