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Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: a systematic review and narrative analysis
- Authors:
- VAN DEN AKKER Natalie, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 34(2), 2021, pp.327-389.
- Publisher:
- Wiley
Background: Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour. Method: A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities. Results: Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour. Conclusions: The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors. (Edited publisher abstract)
Your guide to taking medicine for behaviour problems: easy read
- Authors:
- UNWIN Gemma, DEB Shoumitro
- Publisher:
- University of Birmingham
- Publication year:
- 2006
- Pagination:
- 15p.
- Place of publication:
- Birmingham
This guidance provides advice for patients who are receiving medication to manage behaviour problems with a learning disability. It aims to facilitate the care process and to improve the way that behaviour problems are managed, thus leading to a better quality of life for people with a learning disability.
Toward data-based clinical decision making for adults with challenging behavior using the Behavior Problems Inventory-Short Form (BPI-S)
- Authors:
- BOWRING Darren L., et al
- Journal article citation:
- Tizard Learning Disability Review, 23(2), 2018, pp.103-110.
- Publisher:
- Emerald
Purpose: The Behavior Problems Inventory-Short Form (BPI-S) is a shorter version of the Behavior Problems Inventory-01. In this paper, BPI-S population norms are reported from a total administrative population of adults with intellectual disability (ID). To facilitate the use of the BPI-S in clinical services to assess behaviour change, the purpose of this paper is to describe how to use BPI-S clinically significant and reliable change (RC) scores. Design/methodology/approach: Data were gathered on 265 adults with ID known to services. Proxy informants completed the BPI-S on challenging behaviours over the previous six months. Clinically significant cut-off values and RC scores were calculated using the Jacobson and Truax’s (1991) method. Findings: BPI-S clinical reference data are presented to provide benchmarks for individual and group comparisons regarding challenging behaviour. Examples demonstrate how to use clinical norms to determine change. Practical implications: Behaviour change is a major goal of researchers and practitioners. Data from the present study can make the BPI-S a valuable tool for determining change in challenging behaviour following service input or intervention. Originality/value: Whilst well used in research, the BPI-S may be less extensively used in practice. This present study provides data to enable researchers and practitioners to use the BPI-S more widely in assessing clinical outcomes, such as intervention research and service evaluation. (Edited publisher abstract)
An evaluation of a behavioural support team for adults with a learning disability and behaviours that challenge from a multi-agency perspective
- Authors:
- CHRISTOPHER Rose, HORSLEY Sarah
- Journal article citation:
- British Journal of Learning Disabilities, 44(3), 2016, p.194–203.
- Publisher:
- Wiley
The Dudley Behavioural Support Team (BST) was set up based on Positive Behavioural Support (PBS) principles to support individuals with behaviours that challenge. The Winterbourne Review emphasises the importance of developing high-quality specialist community services and the Ensuring Quality Services (Local Government Association & NHS England, Ensuring quality services, London, 2014) document was released to guide the commissioning of such services. The document sets out standards and guidance for those supporting individuals with behaviour that challenges. This evaluation aimed to investigate whether the BST meets the guidance set out in Ensuring Quality Services from the perspective of other services. A questionnaire was developed to collect data from 19 staff members from services with experience of working with the BST, to address the points raised in Ensuring Quality Services. The quantitative results indicated that the BST are meeting the guidance to a high standard and qualitative data suggested this is achieved through a focus on joint working and a fluid, flexible approach. In conclusion, the BST appears to be a valuable resource from the perspective of services working with them to support individuals with behaviours that challenge. (Publisher abstract)
Identification of PTSD in adults with intellectual disabilities in five patients in a specialised psychiatric inpatient unit
- Authors:
- BAKKEN Trine Lise, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(2), 2014, pp.91-102.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe and discuss assessment of post-traumatic stress disorder (PTSD) in adults with intellectual disabilities. Existing research in this area encompasses case studies, and includes, for the most part, persons with mild intellectual disabilities. Design/methodology/approach: The aim of this study is to investigate symptom presentation and subsequent identification of PTSD in persons with more severe intellectual disabilities; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about the patients was collected through case files and interviews with key informants: family, milieu therapists, and caregivers in community settings, and observations through inpatient admission. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. The five patients all met criteria for PTSD according to the Diagnostic Manual – Intellectual Disability. Findings: Previously, it was not suspected that the five patients suffered from PTSD, although they had experienced terrifying incidents. All patients displayed severe changes in behaviour, which may have overshadowed symptoms of PTSD. PTSD in persons with more severe intellectual disabilities may be interpreted as challenging behaviour, or other psychiatric disorders such as psychosis. Research limitations/implications: The limitation of the study is the small number of participants. Practical implications: Practical implication is linked to clinical practice related to identification of PTSD in persons with intellectual disabilities. Originality/value: The paper may encourage more research into how PTSD can be identified in persons with moderate and severe intellectual disabilities. The case reports may help clinicians to look for traumatic experiences in persons with intellectual disabilities who have experienced terrifying incidents. (Publisher abstract)
The use of medication to manage behaviour problems in adults with an intellectual disability: a national guideline
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 4(3), September 2010, pp.4-11.
- Publisher:
- Emerald
This article provides an overview of the development and contents of a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. MENCAP commissioned the University of Birmingham Neuropsychiatry and Intellectual Disabilities Research Group to develop the guideline and it was produced in association with the Royal College of Psychiatrists’ Learning Disability Faculty and the College Research and Training Unit. The guideline was produced following the methods used by the National Institute for Health and Clinical Excellence, and included a systematic literature review. This guide neither recommends nor rejects the use of psychotropic medications for the management of problem behaviours in adults with learning disabilities, but concentrates on good practice such as employing clear rationales following thorough assessments of individual patients and careful monitoring and recording of use and withdrawal. Twenty-five main recommendations for practice which are provided in the ‘Quick Reference Guide’ are listed in the article. The importance of access to ‘easy-read medication information leaflets’ for people with learning disabilities to be able to make choices is also highlighted.
Informal support and burden among parents of adults with intellectual and/or developmental disabilities
- Authors:
- ROBINSON Suzanne, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, p.356–365.
- Publisher:
- Wiley
Background: Parents often play a lifelong role in supporting their sons and daughters with intellectual and/or developmental disabilities (IDD). There is a need to better understand parent resources, particularly when the individual with IDD has behaviour problems, as the latter has consistently been linked to parental burden. Methods: The current study aimed to investigate the relationship between the behaviour support needs of 212 adults with IDD and parental burden, and whether perceived helpfulness of informal supports moderated this relationship. The helpfulness of individual sources of informal support was also explored. Results: Informal support was negatively related to burden, although it did not act as a moderator. Individual sources varied in terms of how they were related to burden, but none acted as moderators. Conclusions: Although informal social support appears to be important to parents and may help alleviate burden, it does not appear to act as a moderator as anticipated. (Publisher abstract)
Identifying the prevalence of aggressive behaviour reported by Registered Intellectual Disability Nurses in residential intellectual disability services: an Irish perspective
- Authors:
- CROTTY Gerard, DOODY Owen, LYONS R.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(3), 2014, pp.174-187.
- Publisher:
- Emerald
Purpose: Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach: This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs’ within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. Totally, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings: The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value: The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland. (Publisher abstract)
A multi-centre audit of the use of medication for the management of behavioural problems in adults with intellectual disabilities
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- British Journal of Learning Disabilities, 36(2), June 2008, pp.140-143.
- Publisher:
- Wiley
The aim was to investigate prescribing practices surrounding the use of medication for the management of behavioural problems in adults with intellectual disabilities with reference to a national guideline development project. A case note review methodology was employed to explore adherence to the audit criteria that were derived from the recommendations made in the guideline. A total of 154 cases were identified as meeting the inclusion criteria. There was some variation in adherence to the examined audit criteria with some areas achieving high compliance whereas others were deemed as lacking. Such areas achieving high compliance included assessment of the behaviour, assessment of surrounding behavioural, medical, psychological/psychiatric and social issues and communication of the treatment plan to other relevant professionals. However, the assessment of capacity issues and acquisition of consent or assent were rarely documented. The results highlighted certain areas of clinical practice that may need to be formally documented in patient case notes in order to provide evidence of the quality of healthcare an individual has received.
Critical literature review: effectiveness of individual psychodynamic psychotherapy for adults with intellectual disabilities
- Author:
- MCINNIS Erica E.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(4), 2016, pp.233-247.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs). Design/methodology/approach: Literature review. Findings: In total, 14 papers were reviewed. From these, one existing review and seven individual papers provided enough evidence to support effectiveness of individual psychodynamic psychotherapy for people with IDs. Research limitations/implications: This research indicates individual psychodynamic psychotherapy to be of benefit. Indeed, all studies reviewed supported individual psychodynamic psychotherapy, but methodological shortcomings weakened the confidence placed in findings for some studies. Limitations of this review include methodological shortcomings of studies reviewed, a small number of existing studies and reliance on case studies. Practical implications: Therapists and commissioners of services should routinely make individual psychodynamic psychotherapy available as part of a spectrum of therapies available to people with IDs who experience emotional and behavioural problems. This is because it is needed for some clients and they benefit. Social implications: Individual psychodynamic psychotherapy for people with IDs adds to the range of therapies available to alleviate emotional distress and enhance well-being. These are necessary to provide a foundation for meaningful contribution to society, particularly for those who have experienced psychological trauma (Frankish, 2016). Originality/value: This review includes more relevant studies than previous reviews and adds to a limited number of reviews in this area. (Publisher abstract)