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Screening for psychiatric disorders in a total population of adults with intellectual disability and challenging behaviour using the PAS-ADD checklist
- Authors:
- ALLEN David, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 25(4), July 2012, pp.342-349.
- Publisher:
- Wiley
The nature of the relationship between psychiatric disorders and challenging behaviour in people with intellectual disabilities is the subject of debate; a picture that is confused by challenging behaviour itself sometimes being classified as a form of psychiatric disorder. The authors explore this relationship in a population sample of adults with challenging behaviour. More than 800 service settings in a defined geographical area in Wales were screened to identify individuals with challenging behaviour. Detailed behavioural data, Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD) checklist and Adaptive Behaviour Scale (Part 1) scores were collected for 76% of the 930 adults identified. Just under 17% of participants reached threshold scores on one on more subscales of the PAS-ADD checklist. There was some evidence of increasing behavioural severity being associated with increasing psychiatric symptoms but there were no associations between specific forms of challenging behaviour and individual symptoms. The authors conclude that these data support previous suggestions that it is unlikely that the majority of challenging behaviours in adults with intellectual disability are underpinned by psychiatric disorders.
Brief report: changes in admissions to a hospital for people with intellectual disabilities following the development of alternative community services
- Author:
- ALLEN David
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 11(2), 1998, pp.156-165.
- Publisher:
- Wiley
Examines admissions to a hospital for people with intellectual disabilities over a 20-year period against the background of changes in community-based social and health care provision. Found the development of community support teams had no significant impact on the rate of overall hospital admissions but was associated with a reduction in long-stay admissions. The introduction of specialist services was associated with reductions in rates of both long-and-short-term admissions. The new infrastructure of community services appeared to reduce the dependency on hospital provision over the study period, although it had not proved possible to completely eradicate new long-stay admissions. Methodological problems with the study are discussed.
Predictors of restrictive research strategy use in people with challenging behaviour
- Authors:
- ALLEN David, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.159-168.
- Publisher:
- Wiley
Intrusive reactive strategies (physical restraint, emergency medication and seclusion) are frequently used procedures in the management of challenging behaviour. The present study identifies predictors for reactive strategy use in an attempt to more clearly delineate at risk service users. Eight hundred and thirty-nine agencies and service settings in a large area of South Wales were screened to identify children and adults with challenging behaviour against a number of defined operational criteria. Full data were available for 901 participants. Univariate and multivariate statistics were employed to identify predictors for reactive strategy use. The individuals most at risk of the use of reactive strategies were those who were subject to formal detention under the Mental Health Act (restraint and sedation), had more severe challenging behaviour (seclusion), showed destructive behaviour (restraint and seclusion) were placed out of area (seclusion) and had behavioural plans in place for specific topographies (restraint and sedation).
Parents' use of physical interventions in the management of their children's severe challenging behaviour
- Authors:
- ALLEN David, COOPER Viv
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(4), December 2006, pp.356-363.
- Publisher:
- Wiley
Although training staff supporting people with challenging behaviour in physical interventions has become accepted practice, parents are often left to fend for themselves while managing equivalent behaviours. The study explores parents' experience of managing severe challenging behaviours, their use of physical interventions and access to training in reactive strategies. A postal survey methodology was employed that utilized a novel 20-item questionnaire. The questionnaire yielded both quantitative and qualitative data concerning the types of challenging behaviour displayed by the children, frequency of use and nature of physical interventions, types of training received and any difficulties experienced in obtaining training. The sample was drawn from the membership of the Challenging Behaviour Foundation, a UK charitable organization, and comprised of 72 respondents. The majority of respondents had experienced major episodes of challenging behaviour. The emotional impact of living with such behaviours was apparent. Although the vast majority of respondents had employed restrictive physical interventions, few had received any formal training in such strategies. There was evidence that a number of high-risk physical interventions were sometimes being employed. Accessing training appeared more problematic for parents when compared with paid care staff. In this specific sample, parental use of physical intervention was high while parent training in physical intervention was uncommon. Impediments to parent training in physical intervention are discussed, as are wider issues concerning parental support.
The use of physical interventions with people with intellectual disabilities and challenging behaviour: the experiences of service users and staff members
- Authors:
- HAWKINS Sarah, ALLEN David, jENKINS Rosemary
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 18(1), March 2005, pp.19-34.
- Publisher:
- Wiley
The views of both service users with intellectual disability and their support staff on the use of physical interventions are largely unknown. The research that does exist describes a largely negative pattern of responses. The present study aimed to explore the personal impact of receiving and implementing physical interventions, and also how service users and staff felt the use of such procedures impacted on each other. Eight service user/staff pairs were interviewed about their experiences of physical intervention within 1 week of their mutual involvement in a behavioural incident requiring restraint use. A qualitative methodology was employed to obtain views on a non-pain compliance approach to physical intervention. Service user and staff experiences were intrinsically linked, highlighting the interactional nature of physical interventions. It was apparent that experiences of physical intervention were dependent on far more than the application of techniques alone. Participants’ accounts were primarily negative. Service user and staff experiences were clearly affected by their appraisals of each other's behaviour throughout the physical intervention process.
The impact of service user cognitive level on carer attributions for aggressive behaviour
- Authors:
- TYNAN Hannah, ALLEN David
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 15(3), September 2002, pp.213-223.
- Publisher:
- Wiley
This article is based on a study designed to test the hypothesis that carer attributions for aggressive behaviour vary according to a service user's severity of intellectual disability. Forty-two residential care staff participated in an investigation examining the effects of the level of a service user's intellectual disability on causal attributions for their aggressive behaviour. Equal numbers of participants were assigned to either a 'mild disability' or a 'severe disability' condition and required to read a vignette depicting a service user with aggressive challenging behaviour. The service user depicted in the mild disabilities condition was perceived to have significantly greater control over factors causing the aggressive behaviour than the service user in the severe disabilities condition. Participants in the severe disabilities condition considered the aggression to be significantly more challenging. Learned behaviour and emotional causal models of aggressive behaviour were favoured, whilst the physical environment account was seen as least appropriate. Additionally, the biomedical model was rated as significantly more applicable in the severe disability condition than in the mild disability condition.
Success and failure in community placements for people with learning difficulties and challenging behaviour: an analysis of key variables
- Author:
- ALLEN David
- Journal article citation:
- Journal of Mental Health, 8(3), June 1999, pp.307-320.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This study examines the differences in the individual and service characteristics of two groups of people with learning disability and challenging behaviour, one which was successfully maintained in the community and one which experienced placement breakdown. Looks the differences between the two groups in relation to service users and carers. Discusses the implications for future research and clinical practice.