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Psychological interventions for severely challenging behaviours shown by people with learning disabilities: clinical practice guidelines
- Authors:
- BALL Tina, et al
- Publisher:
- British Psychological Society
- Publication year:
- 2004
- Pagination:
- 96p.
- Place of publication:
- Leicester
In essence, the guidelines propose that positive behavioural support (PBS) is the benchmark for intervention in the field of challenging behaviours. There are 52 guidelines in total, each of which is based on research evidence and described as either 'essential' or 'good' practice. Three essential core guidelines set out the value base of PBS. They focus on recognising the person's unique strengths and needs and unique social context, adopting a coherent process of assessment-driven intervention and considering the person and the environment as well as the behaviour. Assessment is therefore idiographic rather than diagnostic; intervention is systemic as much as intra-psychic. Seeking consent before assessment, maintaining confidentiality, eliciting feedback, assessing risk and preventing abuse are all essential practice.
Providing care for adults with autistic spectrum disorders in learning disability services: needs-based or diagnosis-driven?
- Authors:
- BENNETT Heather E., WOOD Clare L., HARE Dougal Julian
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 18(1), March 2005, pp.57-64.
- Publisher:
- Wiley
This study assessed whether a Learning Disability Service should develop a specific autism strategy or provide services on a needs-led basis. An autism screening questionnaire had been used to identify individuals scoring above a cut-off who had (n = 9) or had not (n = 15) received a formal diagnosis of autism. A sample of low scorers (n = 22) were matched to these groups. Questionnaires assessing service provision, needs (disabilities and challenging behaviour), quality of life and knowledge of autism were sent to relatives of individuals living at home or key-workers for those living in supported housing. The high scoring groups had similar levels of needs. Those diagnosed with autism received more services in total while the high scoring group without autism diagnoses scored significantly lower on quality of life. Although these differences were not maintained when level of disability was taken into account, it appeared that there was some level of unmet need in the high scorers without autism diagnoses group. It appeared that resources should be targeted at identifying and addressing the specific needs of individuals presenting with autistic spectrum difficulties.
The differences between sex offending and challenging behaviour in people with an intellectual disability
- Author:
- DOYLE David Michael
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 29(2), June 2004, pp.107-118.
- Publisher:
- Taylor and Francis
This paper differentiates between sexual offending behaviour and challenging behaviour in people with an intellectual disability. There is growing awareness that people with an intellectual disability can perform both classes of behaviour. The definitions of sexual offending and challenging behaviour are almost interchangeable, due to the poor construction of the term challenging behaviour. It is when clinicians attempt to view sexual offending from within the framework and underpinning philosophy of the challenging behaviour model that the magnitude of the mismatch emerges. In this paper, the basic definitions are elaborated on and the different models of assessment discussed, as is the approach taken towards the treatment of the two kinds of behaviour. The corresponding notions of intent, criminal intent and communicative intent are also compared. The implications of interpreting sex offending behaviour as challenging behaviour are highlighted. In the conclusion of this discussion functional analysis is put forward as a technique that may aid in the assessment of sex offending.
Developmental Behaviour Checklist (DBC) in the assessment of psychopathology in Finnish children with intellectual disability
- Authors:
- KOSKENTAUSTA Terhi, ALMQVIST Fredrik
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 29(1), March 2004, pp.27-39.
- Publisher:
- Taylor and Francis
This study evaluates the Developmental Behaviour Checklist (DBC) in the assessment of psychopathology in a Finnish population of children with intellectual disability. Disruptive behaviour was more common in children with mild intellectual disability, and problems with social interaction and communication in those with moderate, severe or profound intellectual disability. The frequency of psychiatric disturbances was approximately 34 percent, with the highest rate occurring in children with moderate intellectual disability. Compared with the original standardisation data published by Einfeld and Tonge (1994), the mean Total Behaviour Problem Score (TBPS) and frequency of psychiatric disturbance were lower. This study suggests that the DBC is a good instrument for discriminating between children with intellectual disability with and without emotional or psychiatric disturbance.
Behavioural misdiagnosis
- Author:
- REEVES Simon
- Journal article citation:
- Nursing Times, 7.5.97, 1997, pp.44-45.
- Publisher:
- Nursing Times
Discusses how neurological disorders in people with learning difficulties may be responsible for confusing signals for both clients and health care professionals.
Psychiatric diagnoses in relation to severity of intellectual disability and challenging behaviors: a register study among older people
- Authors:
- AXMON A., et al
- Journal article citation:
- Aging and Mental Health, 22(10), 2018, pp.1344-1350.
- Publisher:
- Taylor and Francis
Objective: To investigate the possible association between severity of intellectual disability (ID) and presence of challenging behaviour, respectively, on diagnoses of psychiatric disorders among older people with ID. Methods: People with a diagnosis of ID in inpatient or specialist outpatient care in 2002–2012 were identified (n = 2147; 611 with mild ID, 285 with moderate ID, 255 with severe or profound ID, and 996 with other/unspecified ID). Moreover, using impairment of behaviour as a proxy for challenging behaviour, 627 people with, and 1514 without such behaviour were identified. Results: Severe/profound ID was associated with lower odds of diagnoses of psychotic, affective, and anxiety disorders than was mild/moderate ID. People with moderate ID had higher odds than those with mild ID of having diagnoses of affective disorders. Diagnoses of psychotic, affective, and anxiety disorders, and dementia were more common among people with challenging behaviour than among those without. Conclusions: People with severe/profound ID had lower odds of receiving psychiatric diagnoses than those with mild and moderate ID. Whether this is a result of differences in prevalence of disorders or diagnostic difficulties is unknown. Further, challenging behaviours were associated with diagnoses of psychiatric disorders. However, the nature of this association remains unclear. (Edited publisher abstract)
Quality of diagnosis and treatment plans after using the ‘diagnostic guideline for anxiety and challenging behaviours’ in people with intellectual disabilities: a comparative multiple case study design
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(4), 2016, pp.305-316.
- Publisher:
- Wiley
Background: People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. Materials and Methods: A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. Results: The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Conclusions: Working with the ‘Diagnostic Guideline for Anxiety and CB’ leads to improved diagnoses and treatment plans compared with care as usual. (Publisher abstract)
The role of nurses/social workers in using a multidimensional guideline for diagnosis of anxiety and challenging behaviour in people with intellectual disabilities
- Authors:
- PRUIJSSERS Addy, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(13-14), 2015, pp.1955-1965.
- Publisher:
- John Wiley and Sons
Aims and objectives: This study seeks (1) to investigate the impact of the implementation of the ‘Diagnostic Guideline for Anxiety and challenging behaviours in clients with intellectual disability’ on nurses/social workers' knowledge and self-efficacy; and (2) to evaluate the role of nurses/social workers in the diagnostic process when applying the guideline. Background: Nurses/social workers have extensive contact with clients with intellectual disabilities. Despite this key position, the contribution of nurses/social workers to the diagnosis of mental health problems and challenging behaviours is rather limited. The authors developed the multidimensional ‘Diagnostic Guideline for Anxiety and challenging behaviours’. In this article, the implementation of this guideline is evaluated concerning knowledge and self-efficacy of nurses/social workers, as well the role of nurses/social workers in the diagnostic process. Design: This study employed a comparative multiple case study design. Methods: Qualitative and quantitative research methods. Results: Working with the ‘Diagnostic Guideline for Anxiety and challenging behaviours’ led to a statistically significant increase in knowledge and self-efficacy among the nurses/social workers in the experimental condition, compared with nurses/social workers in the control condition. Nurses/social workers and psychologists appreciated the more active contribution of the nurses/social workers in the diagnostic process. Conclusions: Working with the guideline increased the knowledge and self-efficacy of nurses/social workers, and led to more active participation of nurses/social workers in the diagnostic process. Relevance to clinical practice: After following a training programme, nurses/social workers can effectively contribute to the diagnostic process in clients with anxiety and related challenging behaviours. (Publisher abstract)
Post-traumatic stress disorder and people with learning disabilities: a literature based discussion
- Authors:
- DOYLE Colin, MITCHELL Duncan
- Journal article citation:
- Journal of Learning Disabilities, 7(1), March 2003, pp.23-33.
- Publisher:
- Sage
People with learning disabilities may experience emotional traumas that impact upon their ability to enjoy life. Much of this trauma mnaifests itself in challenging behaviour. The authors discuss key points from the literature and suggest that post-traumatic stress disorder in people with learning disabilities often goes unrecognised.
Hearing loss in people with learning disabilities
- Author:
- YEATES Sybil
- Journal article citation:
- Tizard Learning Disability Review, 3(2), April 1998, pp.20-28.
- Publisher:
- Emerald
This article demonstrates the lack of importance which, until recently, has been accorded to the distinction between hearing loss and learning disability when they occur together. It then emphasises the problems which this has caused, including challenging behaviour. A summary of the causes common to both learning disability and hearing loss is given, along with brief description of tests used to diagnose hearing loss in the learning-disabled. The importance of team work is stressed, together with the necessity of education for all personnel working with the learning-disabled. Some ideas contributing to rehabilitation are suggested and the importance of restoring some hearing even to the most severely handicapped is described.