Advances in Mental Health and Intellectual Disabilities, 6(4), 2012, pp.199-214.
Publisher:
Emerald
This review, the first in a two-part series, explores challenging behaviour in adults, its prevalence, risk factors and causes. It aims to provide an overview of prevalence studies and explore the various risk factors that have been associated with challenging behaviour. The authors also seek to explore methodological differences across studies that may contribute to the prevalence variations reported in the literature. The article summarises the findings from frequently cited prevalence studies as well as more recent studies. The prevalence of challenging behaviour reported in the literature has varied due to methodological differences across studies. Despite this, the best estimate is believed to be from 15 to 17.5 per cent. A range of factors have been associated with challenging behaviour and include gender, age, severity of disability and residential setting.
This review, the first in a two-part series, explores challenging behaviour in adults, its prevalence, risk factors and causes. It aims to provide an overview of prevalence studies and explore the various risk factors that have been associated with challenging behaviour. The authors also seek to explore methodological differences across studies that may contribute to the prevalence variations reported in the literature. The article summarises the findings from frequently cited prevalence studies as well as more recent studies. The prevalence of challenging behaviour reported in the literature has varied due to methodological differences across studies. Despite this, the best estimate is believed to be from 15 to 17.5 per cent. A range of factors have been associated with challenging behaviour and include gender, age, severity of disability and residential setting.
Mental Health Review Journal, 14(2), June 2009, pp.28-36.
Publisher:
Emerald
Aggressive behaviour is a problem for services providing care for people with intellectual disabilities, affecting the quality of life of the individual and the quality of care provided. Current research trends, which focus on risk factors and mental health problems, are discussed. Other factors that could contribute to aggression in people with intellectual disability (PWID), such as lifestyle and environmental issues are examined. A methodology that would allow for the integration of all these factors, Behavioural Sequence Analysis, is a suitable investigative approach to this problem.
Aggressive behaviour is a problem for services providing care for people with intellectual disabilities, affecting the quality of life of the individual and the quality of care provided. Current research trends, which focus on risk factors and mental health problems, are discussed. Other factors that could contribute to aggression in people with intellectual disability (PWID), such as lifestyle and environmental issues are examined. A methodology that would allow for the integration of all these factors, Behavioural Sequence Analysis, is a suitable investigative approach to this problem.
Journal of Intellectual Disability Research, 53(3), March 2009, pp.217-232.
Publisher:
Wiley
This study investigates point prevalence, 2-year incidence and 2-year remission rates for aggressive behaviour (physically aggressive, destructive and verbally aggressive), and it investigates which factors are independently associated with aggressive behaviour. All adults with ID – within a geographically defined area of Scotland, UK – were recruited to a longitudinal cohort. At baseline, assessments were undertaken of demography, lifestyle, supports, development, problem behaviours, disabilities and physical and mental health. These were repeated for a 2-year period. At baseline, the participation rate was 1023 (65.5%). After 2 years, the cohort retention was 651 adults. The point prevalence of Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) aggressive behaviour was 9.8%, 2-year incidence was 1.8%, and 2-year remission rate from all types of aggressive behaviour meeting DC-LD criteria was 27.7%. The factors independently associated with aggressive behaviours were lower ability, female gender, not living with a family carer, not having Down syndrome, having attention-deficit hyperactivity disorder and having urinary incontinence. Incidence of aggressive behaviour meeting DC-LD criteria in adult life is similar to that for each of psychotic, anxiety and organic disorders. Aggressive behaviour is common among adults with ID, but contrary to previous suggestions, more than a quarter remit within the short to medium term.
This study investigates point prevalence, 2-year incidence and 2-year remission rates for aggressive behaviour (physically aggressive, destructive and verbally aggressive), and it investigates which factors are independently associated with aggressive behaviour. All adults with ID – within a geographically defined area of Scotland, UK – were recruited to a longitudinal cohort. At baseline, assessments were undertaken of demography, lifestyle, supports, development, problem behaviours, disabilities and physical and mental health. These were repeated for a 2-year period. At baseline, the participation rate was 1023 (65.5%). After 2 years, the cohort retention was 651 adults. The point prevalence of Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) aggressive behaviour was 9.8%, 2-year incidence was 1.8%, and 2-year remission rate from all types of aggressive behaviour meeting DC-LD criteria was 27.7%. The factors independently associated with aggressive behaviours were lower ability, female gender, not living with a family carer, not having Down syndrome, having attention-deficit hyperactivity disorder and having urinary incontinence. Incidence of aggressive behaviour meeting DC-LD criteria in adult life is similar to that for each of psychotic, anxiety and organic disorders. Aggressive behaviour is common among adults with ID, but contrary to previous suggestions, more than a quarter remit within the short to medium term.
Subject terms:
learning disabilities, mental health problems, risk, aggression, challenging behaviour;
This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
Extended abstract:
Author
POWELL Sharon.
Title
Risk in challenging behaviour: a good practice guide for professionals.
Publisher
British Institute of Learning Disabilities, 2005
Summary
This guide is designed to help with establishing a framework to support individuals with learning disabilities or autistic spectrum disorders whose behaviour challenges services and presents a risk to themselves or others. It sets out in clear and simple terms a structured and systematic approach to the identification, assessment and management of risks associated with challenging behaviours.
Context
Risk is an evolving concept; it is changing and rarely stays the same from one day to the next. Individuals are prepared to take calculated risks in their daily lives for a variety of reasons. Professionals are expected to identify and manage risk objectively. Reactive strategies for risk management when behaviour challenges should form part of an overall framework. This should include approaches that support positive behaviour. Physical interventions should be used only as a last resort.
Contents
A foreword explains recent developments and an introduction outlines the problem and the intentions of the guide. The first section, on philosophical and organisational issues, discusses organisational foundations, the nature of risk, taking risks, procedures for working with risk, why risk should be assessed, and the elements of risk. The second, on assessing risk, covers risk scoring, identifying hazards and risks, the risk assessment process, describing the challenging behaviour, articulating risk, managed and unmanaged risk, the assessment process, what might go wrong, and physical interventions in the context of risk assessment. Two sets of checklists are given, on procedures for working with risk, consisting of three lists, for developing risk policies, service user vulnerability, and breaking confidentiality; and on risk assessment process, with four lists, for information gathering, planning and consultation, implementation and monitoring, and evaluation and review. Three pro formas are also given, for behaviour description, articulating risk and assessment of service user vulnerability.
BOWRING Darren L., TOTSIKA Vasiliki, HASTINGS Richard P.
Journal article citation:
British Journal of Clinical Psychology, 56(1), 2017, pp.16-32.
Publisher:
Wiley
Objectives: Considerable variation has been reported in the prevalence and correlates of challenging behaviour (CB) in adults with intellectual disabilities (ID). To provide a robust estimate of prevalence, we identified the entire administrative population of adults with ID in a defined geographical area and used a behaviour assessment tool with good psychometric properties.
Methods: Data from 265 adults who were known to services were collected using a demographic survey tool and the Behavior Problems Inventory – Short Form. The prevalence of self-injurious, aggressive/destructive, stereotyped, and overall CB was evaluated. We explored the potential of developing cumulative risk indices (CRI) to inform longitudinal research and clinical practice.
Results: The prevalence of overall CB was 18.1%. The prevalence of self-injurious behaviour was 7.5%, aggressive–destructive behaviour 8.3%, and stereotyped behaviour 10.9%. Communication problems and severity of ID were consistently associated with higher risk of CBs. CRIs were significantly associated with CBs, and the five methods of CRI development produced similar results.
Conclusions: Findings suggest a multi-element response to CB is likely to be required that includes interventions for communication and daytime activity. Exploratory analyses of CRIs suggested these show promise as simple ways to capture cumulative risk in this population. Subject to longitudinal replication, such a tool may be especially useful in clinical practice to identify adults who are priority for interventions and predict future demand on services.
(Edited publisher abstract)
Objectives: Considerable variation has been reported in the prevalence and correlates of challenging behaviour (CB) in adults with intellectual disabilities (ID). To provide a robust estimate of prevalence, we identified the entire administrative population of adults with ID in a defined geographical area and used a behaviour assessment tool with good psychometric properties.
Methods: Data from 265 adults who were known to services were collected using a demographic survey tool and the Behavior Problems Inventory – Short Form. The prevalence of self-injurious, aggressive/destructive, stereotyped, and overall CB was evaluated. We explored the potential of developing cumulative risk indices (CRI) to inform longitudinal research and clinical practice.
Results: The prevalence of overall CB was 18.1%. The prevalence of self-injurious behaviour was 7.5%, aggressive–destructive behaviour 8.3%, and stereotyped behaviour 10.9%. Communication problems and severity of ID were consistently associated with higher risk of CBs. CRIs were significantly associated with CBs, and the five methods of CRI development produced similar results.
Conclusions: Findings suggest a multi-element response to CB is likely to be required that includes interventions for communication and daytime activity. Exploratory analyses of CRIs suggested these show promise as simple ways to capture cumulative risk in this population. Subject to longitudinal replication, such a tool may be especially useful in clinical practice to identify adults who are priority for interventions and predict future demand on services.
(Edited publisher abstract)
Drawing on existing literature regarding rates of emotional and behavioural difficulties together with risk factors, the authors present a rationale for increasing initiatives for early intervention of emotional and behaviour difficulties. The study finds rates of emotional and behavioural difficulties amongst children with learning and developmental difficulties are high. A combination of factors relating to the child, the family system, and wider social contexts is likely to account for this. Increased attempts to provide early intervention to children with learning and developmental disabilities together with their families are warranted. Recommendations are made regarding how the development of such supports might best be taken forward.
(Edited publisher abstract)
Drawing on existing literature regarding rates of emotional and behavioural difficulties together with risk factors, the authors present a rationale for increasing initiatives for early intervention of emotional and behaviour difficulties. The study finds rates of emotional and behavioural difficulties amongst children with learning and developmental difficulties are high. A combination of factors relating to the child, the family system, and wider social contexts is likely to account for this. Increased attempts to provide early intervention to children with learning and developmental disabilities together with their families are warranted. Recommendations are made regarding how the development of such supports might best be taken forward.
(Edited publisher abstract)
Advances in Mental Health and Intellectual Disabilities, 8(1), 2014, pp.32-42.
Publisher:
Emerald
Purpose: Challenging behaviours are defined in part by the risks of harm they present and the support of individuals who challenge would be improved with effective assessments of the risks posed by challenging behaviours. The purpose of this paper is to outline a model of risk assessment and review literature that provides relevant information.
Design/methodology/approach: Literature review.
Findings: Forensic risk assessment has a well worked-out and validated approach but tools used to assess challenging behaviours are not effective risk predictors. Applied Behaviour Assessment provides methods that can be more effectively used for risk assessment.
Practical implications: There is a need to develop valid risk assessment procedures for assessing the risks presented by challenging behaviours.
Originality/value: This is a fresh perspective on risk assessment in relation to challenging behaviours.
(Publisher abstract)
Purpose: Challenging behaviours are defined in part by the risks of harm they present and the support of individuals who challenge would be improved with effective assessments of the risks posed by challenging behaviours. The purpose of this paper is to outline a model of risk assessment and review literature that provides relevant information.
Design/methodology/approach: Literature review.
Findings: Forensic risk assessment has a well worked-out and validated approach but tools used to assess challenging behaviours are not effective risk predictors. Applied Behaviour Assessment provides methods that can be more effectively used for risk assessment.
Practical implications: There is a need to develop valid risk assessment procedures for assessing the risks presented by challenging behaviours.
Originality/value: This is a fresh perspective on risk assessment in relation to challenging behaviours.
(Publisher abstract)
Subject terms:
assessment, literature reviews, risk, challenging behaviour, learning disabilities, mental health problems;
Social Work: A journal of the National Association of Social Workers (NASW), 58(3), 2013, pp.213-221.
Publisher:
Oxford University Press
Self-injurious behavior (SIB) is a distressing type of problem behaviour that may be exhibited in individuals with intellectual disabilities (IDs). This article provides an overview of SIB, its underlying causes and functions, as well as other key variables associated with its manifestation. Adults with IDs are routinely living longer. Given this rapidly emerging and expanding population, special attention is given to SIB in aging adults with IDs that may result from age-related risk factors. Risks include increasing and unresolved health issues, physical changes, declining physical abilities, transitions to new residential environments, and the potential for experiencing loss and bereavement. The article concludes with practice implications for social workers who may encounter older individuals with IDs and SIB.
(Publisher abstract)
Self-injurious behavior (SIB) is a distressing type of problem behaviour that may be exhibited in individuals with intellectual disabilities (IDs). This article provides an overview of SIB, its underlying causes and functions, as well as other key variables associated with its manifestation. Adults with IDs are routinely living longer. Given this rapidly emerging and expanding population, special attention is given to SIB in aging adults with IDs that may result from age-related risk factors. Risks include increasing and unresolved health issues, physical changes, declining physical abilities, transitions to new residential environments, and the potential for experiencing loss and bereavement. The article concludes with practice implications for social workers who may encounter older individuals with IDs and SIB.
(Publisher abstract)
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).
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).
Journal of Intellectual Disability Research, 53(3), March 2009, pp.255-264.
Publisher:
Wiley
Aggression is a common type of problem behaviour in clients with mild to borderline intellectual disability who live in a residential facility. This study explored contextual events that elicit aggressive behaviour and variables that were associated with such events. Respondents were 87 direct-care staff members of 87 clients with aggressive behaviour who lived in a residential facility. Staff members completed the Contextual Assessment Inventory (CAI) and a questionnaire on demographic information and types, frequency and severity of aggressive behaviour. Internal consistency of the total CAI was excellent. Both social and task-related events were reported to evoke aggressive behaviour of clients most often. Negative interactions, task characteristics and daily routines relatively often evoked aggressive behaviour while an uncomfortable environment, medication, illness and physiological states (i.e. physical and biological events) evoked aggressive behaviour least often. Mean CAI sub-scale scores were significantly related to gender, IQ and frequency of aggressive behaviour. The present study extends our knowledge regarding events that are associated with an increased probability of aggressive behaviour. Knowledge of these contextual variables may be helpful in designing programmes (e.g. applied behaviour analysis, social skills training and cognitive behavioural therapies) for the management and prevention of aggressive behaviour in clients with mild to borderline intellectual disability who live in a residential facility.
Aggression is a common type of problem behaviour in clients with mild to borderline intellectual disability who live in a residential facility. This study explored contextual events that elicit aggressive behaviour and variables that were associated with such events. Respondents were 87 direct-care staff members of 87 clients with aggressive behaviour who lived in a residential facility. Staff members completed the Contextual Assessment Inventory (CAI) and a questionnaire on demographic information and types, frequency and severity of aggressive behaviour. Internal consistency of the total CAI was excellent. Both social and task-related events were reported to evoke aggressive behaviour of clients most often. Negative interactions, task characteristics and daily routines relatively often evoked aggressive behaviour while an uncomfortable environment, medication, illness and physiological states (i.e. physical and biological events) evoked aggressive behaviour least often. Mean CAI sub-scale scores were significantly related to gender, IQ and frequency of aggressive behaviour. The present study extends our knowledge regarding events that are associated with an increased probability of aggressive behaviour. Knowledge of these contextual variables may be helpful in designing programmes (e.g. applied behaviour analysis, social skills training and cognitive behavioural therapies) for the management and prevention of aggressive behaviour in clients with mild to borderline intellectual disability who live in a residential facility.
Subject terms:
learning disabilities, residential care, risk, aggression, assessment, challenging behaviour;