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Challenging behaviours: prevalence and topographies
- Authors:
- LOWE K., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 51(8), August 2007, pp.625-636.
- Publisher:
- Wiley
Variations in reported prevalence of challenging behaviour indicate the need for further epidemiological research to support accurate planning of future service provision. All services providing for people with learning disabilities across seven unitary authorities, with a total population of 1.2 million, were screened to identify people with challenging behaviour. Interviews were conducted with primary carers to gain data on identified individuals' characteristics and support. Measures designed for a similar study conducted in Manchester University were incorporated to allow direct comparison with earlier findings, together with standardized tools to assess adaptive behaviour and social impairment. In total, 4.5 (2.5–7.5) people per 10,000 population were rated as seriously challenging, representing 10% (5.5–16.8%) of the learning disability population; the most prevalent general form was other difficult/disruptive behaviour, with non-compliance being the most prevalent topography. The majority showed multiple behaviours and multiple topographies within each general behaviour category. Also identified were substantial numbers of additional people reported as presenting challenging behaviours at lower degrees of severity. Prevalence rates for seriously challenging behaviours were comparable to those reported in the earlier studies, thus confirming previous findings. The prevalence of less serious challenging behaviour also has major clinical significance and emphasizes the need for enhanced understanding and skills among personnel within primary- and secondary-tier health, education and social care services, and for strengthening the capacity of community teams to provide behavioural expertise.
Staff-averse challenging behaviour in older adults with intellectual disabilities
- Authors:
- HARTLEY Sigan L., MacLEAN William E.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(6), November 2007, pp.519-528.
- Publisher:
- Wiley
People with intellectual disabilities are increasingly reaching older adulthood. Little is known about age-related change in the prevalence of challenging behaviours among older adults with intellectual disabilities. The frequency and severity of staff-averse challenging behaviours of 132 older adults with intellectual disabilities was assessed through informant ratings on the Inventory of Client and Agency Planning at two time points 8–10 years apart. There was an intraindividual decline in the frequency and severity of challenging behaviour using both lenient and more restricted definitions of challenging behaviour. There was a low prevalence but high comorbidity of severe challenging behaviour. Level of mental retardation and adaptive behaviour were related to the frequency and severity of challenging behaviour. An understanding of age-related intraindividual change in challenging behaviour has implications for staff wellbeing and optimizing the care of older adults with intellectual disabilities.
Modified Overt Aggression Scale (MOAS) for people with intellectual disability and aggressive challenging behaviour: a reliability study
- Authors:
- OLIVER P.C., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(4), July 2007, pp.368-372.
- Publisher:
- Wiley
Reliable measures of aggressive challenging behaviour are required if interventions aimed at reducing this behaviour among people with intellectual disability (ID) are to be formally evaluated. The present authors examined the reliability of the Modified Overt Aggression Scale (MOAS), an instrument not yet formally tested in those with ID, in a sample of people who participated in a randomized trial of neuroleptic medication for aggressive challenging behaviour. Sixty interviews using the MOAS were carried out by two interviewers 2–5 days apart with 23 carers of 14 people who had shown aggressive challenging behaviour. Level of agreement between these two ratings was examined for four subscales of aggression and for total MOAS score. The level of agreement between the raters was high for verbal aggression, physical aggression against others and for total MOAS score. Levels of agreement on the other two subscales were lower but still in the good/moderate range. The MOAS provides a reliable measure of verbal and physical aggression among people with ID who reside in community settings and is suitable for use in studies evaluating the effectiveness of interventions aimed at reducing aggressive challenging behaviour in this group.
Staff training and challenging behaviour: who needs it?
- Author:
- CAMPBELL Martin
- Journal article citation:
- Journal of Intellectual Disabilities, 11(2), June 2007, pp.143-156.
- Publisher:
- Sage
- Place of publication:
- London
Staff working directly with people who have challenging behaviour in learning disability services need to be D good at what they do. These staff are trained by their employers to manage and to treat challenging behaviours and to improve the quality of life of people in their care. While such training is generally well evaluated by care staff, there is limited evidence that training alone changes poor attitudes or improves staff performance. Training has not been linked to quality of outcomes for service users. From research on treating challenging behaviour, achieving maintenance of behavioural gains after treatment has been discontinued is the exception rather than the rule. Can the same be said for maintaining gains achieved through staff training in the area of challenging behaviour? This discussion article reviews the value of training for staff working with people with challenging behaviour.
Organizational and individual factors associated with breakdown of residential placements for people with intellectual disabilities
- Authors:
- BROADHURST S., MANSELL J.
- Journal article citation:
- Journal of Intellectual Disability Research, 51(4), April 2007, pp.293-301.
- Publisher:
- Wiley
People with intellectual disabilities (IDs) whose behaviour challenges services are at increased risk of placement breakdown. Most previous research has tended to focus on the role of individual characteristics in predicting breakdown. A small number of studies have suggested that service variables may impact on intervention effectiveness and hence placement breakdown. This study used a non-experimental group comparison design to investigate potential differences between two groups of residential homes in the South-East of England, one of which had experienced placement breakdown, and one of which had successfully maintained placements in the community. More residents in the breakdown group had inappropriate sexual behaviours but there were no other differences. Services in the breakdown group had more limited procedural guidance for staff, weaker training, supervision and team meetings and less external professional support. Placement characteristics may be an important determinant of community placement success for people with IDs and challenging behaviour. Those selecting and funding residential placements for such people should attend to the technical competence of the placement (in terms of its use of procedural guidance, training and professional advice) and to the extent of support for staff (in terms of training, supervision and team meetings).
Communication and challenging behaviour
- Authors:
- CHALLENGING BEHAVIOUR FOUNDATION, (Producer)
- Publisher:
- Challenging Behaviour Foundation
- Publication year:
- 2007
- Pagination:
- (45 mins.), DVD
- Place of publication:
- Chatham
Using interviews with two parent carers, and with specialist input from Peter McGill (Senior Lecturer in Learning Disability at the University of Kent at Canterbury Tizard Centre), this 40 minute video gives a basic introduction to challenging behaviour associated with severe learning disabilities. The video has been produced for parents and carers of individuals with severe learning disabilities and challenging behaviour, or anyone wanting to understand what it can be like for the families involved.
A preliminary investigation into the utility of the adult behavior checklist in the assessment of psychopathology in people with low IQ
- Authors:
- TENNEIJ Nienke H., KOOT Hans M.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.391-400.
- Publisher:
- Wiley
Background Achenbach & Rescorla (2003) recently developed the Adult Behavior Checklist (ABCL) to assess psychopathology in the general population. The ABCL should be completed by a proxy informant. The use of proxy informants, instead of self-reporting, makes the ABCL potentially suitable for the assessment of psychopathology in adults with intellectual disability. The aim of the present study was to examine reliability and validity of the ABCL in 124 adults with mild intellectual disability or low IQ, and severe challenging behaviour referred for residential treatment in the Netherlands. The ABCL was completed by two independent informants to assess inter-rater reliability. To examine the validity of the ABCL, its relationship with three measures of functioning was assessed. Furthermore, association between scales of the ABCL and DSM-IV axis I disorders was examined. The ABCL was reliable in terms of internal consistency of its scales, and inter-rater reliability. Relationships between clusters of axis I DSM-IV disorders and scales of the ABCL were found as expected. Moreover, ABCL scales predicted different measures of functioning. The ABCL appears to be a reliable and valid measure to assess psychopathology in persons with mild intellectual disabilities or low IQ, admitted for treatment in facilities for adults with mild intellectual disability and severe challenging behaviour.
The All Wales Learning Disability Strategy: current status and implications for people with current status and implications for people with mental health needs or severe challenging behaviour
- Authors:
- FELCE David, ALLEN David
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(1), March 2007, pp.33-36.
- Publisher:
- Emerald
This article briefly summarises the main Welsh policy principles that apply to all people with learning disabilities, including those with mental health needs or severe challenging behaviour. The authors briefly review progress in supporting people with complex behavioural needs, reflect on areas where development in practice has not lived up to policy rhetoric and also examine the consequences of this policy to practice gap. The authors then describe current barriers to further service development. Finally they suggest a number of changes that are necessary for the current inadequacies to be resolved.
Can brief workshop interventions change care staff understanding of challenging behaviours?
- Authors:
- DOWEY Alan, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(1), January 2007, pp.52-57.
- Publisher:
- Wiley
The working culture surrounding challenging behaviour may have a strong effect on staff behaviour. As a first step to influencing staff talk about challenging behaviour, the aim of the present study was to explore whether a 1-day training workshop could have an effect on staff causal explanations. Fifty-four front line staff, in six separate groups, completed an adapted version of the Self-Injury Behavioural Understanding Questionnaire (SIBUQ; Oliver et al. 1996) both before and after a 1-day training workshop. The workshops were based on principles of Applied Behaviour Analysis. The SIBUQ comprised questions about causes of challenging behaviours presented in 11 short scenarios. The four possible response options for each scenario reflected behaviourally correct, behaviourally incorrect, internal emotional, and internal organic causal explanations. The number of correct behavioural causal hypotheses increased significantly from pre- to post-training. The proportion of incorrect causal explanations that were behavioural in orientation also increased significantly from pre- to post-training. Staff causal explanations for challenging behaviour can be changed using a relatively brief intervention. Further research is needed to establish whether such changes can be used to influence working culture in challenging behaviour services.
Keeping it together: a guide for support staff working with people whose behaviour is challenging
- Authors:
- WOODWARD Peter, HARDY Steve, JOYCE Theresa
- Publisher:
- Pavilion
- Publication year:
- 2007
- Pagination:
- 86p.
- Place of publication:
- Brighton
This guide has been written for support staff, working with people with learning disabilities, who are new to challenging behaviour or facing it for the first time. It is a self-help guide and provides practical and realistic information on how direct care staff can develop strategies to support people whose behaviour is challenging and develop their skills in this area. This resource has been written in plain English making it ideal for those without formal psychology training. It also includes a section on how people with learning disabilities view challenging behaviour as well as a useful glossary of terms.