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.
British Journal of Forensic Practice, 11(2), July 2009, pp.17-23.
Publisher:
Emerald
This pilot study investigated three historical risk factors for pathological arson identified in Jackson's Only Viable Option theory (Jackson, 1994), which views the act as an adaptive response to circumstances that are difficult to tolerate and which the individual does not have the necessary skills to resolve by appropriate means. Twenty men with mild learning disabilities were recruited from inpatient forensic services. It was hypothesised that there would be a greater incidence of risk factors among individuals with an index offence of arson than those without, and that risk factors would significantly predict an index offence of arson. Significant differences were found between the groups for perceived inability to effect social change and childhood experiences of fire, but not for the family problems under investigation. However, the sample size was too small to draw reliable conclusions on the predictive ability of the risk factors. The findings suggest that perceived inability to effect social change and childhood experiences of fire are risk factors characteristic of men with learning disabilities who have set fires, lending support to elements of Jackson's theory and providing opportunities to develop evidence-based practice. However, the underlying causes of these risk-factor characteristics remain unclear. It is hoped that the present study will help inform the choice of risk factors under investigation and improve the design of a larger study.
This pilot study investigated three historical risk factors for pathological arson identified in Jackson's Only Viable Option theory (Jackson, 1994), which views the act as an adaptive response to circumstances that are difficult to tolerate and which the individual does not have the necessary skills to resolve by appropriate means. Twenty men with mild learning disabilities were recruited from inpatient forensic services. It was hypothesised that there would be a greater incidence of risk factors among individuals with an index offence of arson than those without, and that risk factors would significantly predict an index offence of arson. Significant differences were found between the groups for perceived inability to effect social change and childhood experiences of fire, but not for the family problems under investigation. However, the sample size was too small to draw reliable conclusions on the predictive ability of the risk factors. The findings suggest that perceived inability to effect social change and childhood experiences of fire are risk factors characteristic of men with learning disabilities who have set fires, lending support to elements of Jackson's theory and providing opportunities to develop evidence-based practice. However, the underlying causes of these risk-factor characteristics remain unclear. It is hoped that the present study will help inform the choice of risk factors under investigation and improve the design of a larger study.
The authors investigate whether the expansion of gambling opportunities in Britain could cause problems for some people with a learning disability and highlight the need for appropriate protection.
The authors investigate whether the expansion of gambling opportunities in Britain could cause problems for some people with a learning disability and highlight the need for appropriate protection.
British Journal of Psychiatry, 205(6), 2014, pp.450-457.
Publisher:
Cambridge University Press
Background: People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.
Aims: To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.
Method: Cross-sectional observational study followed by treatment evaluation.
Results: Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.
Conclusions: Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.
(Publisher abstract)
Background: People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.
Aims: To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.
Method: Cross-sectional observational study followed by treatment evaluation.
Results: Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.
Conclusions: Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.
(Publisher abstract)
Subject terms:
injuries, learning disabilities, bone diseases, risk, nutrition;
Journal of Intellectual Disability Research, 53(7), July 2009, pp.575-589.
Publisher:
Wiley
Self-injurious behaviour is frequently identified as part of the behavioural phenotype of Cornelia de Lange syndrome (CdLS). The authors conducted a case-control study of the prevalence and phenomenology of self-injurious behaviour (SIB) in CdLS. A total of 54 participants with CdLS were compared with 46 individuals who were comparable on key variables including age, degree of intellectual disability and wheelchair use, using questionnaire and observational measures. Clinically significant self-injury was not more prevalent in the CdLS group (55.6%), nor was it different in presentation from that seen in the comparison group. Hyperactivity, stereotyped and compulsive behaviours predicted clinically significant self-injury in all participants. Hand directed, mild self-injury was more prevalent in CdLS. The results show that clinically significant self-injury may not be part of the behavioural phenotype of CdLS but a specific body target for proto-SIB is more common.
Self-injurious behaviour is frequently identified as part of the behavioural phenotype of Cornelia de Lange syndrome (CdLS). The authors conducted a case-control study of the prevalence and phenomenology of self-injurious behaviour (SIB) in CdLS. A total of 54 participants with CdLS were compared with 46 individuals who were comparable on key variables including age, degree of intellectual disability and wheelchair use, using questionnaire and observational measures. Clinically significant self-injury was not more prevalent in the CdLS group (55.6%), nor was it different in presentation from that seen in the comparison group. Hyperactivity, stereotyped and compulsive behaviours predicted clinically significant self-injury in all participants. Hand directed, mild self-injury was more prevalent in CdLS. The results show that clinically significant self-injury may not be part of the behavioural phenotype of CdLS but a specific body target for proto-SIB is more common.
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.
This article provides responses from a practice panel on the case of a woman with learning difficulties whose two children were taken into care and adopted, and who is now pregnant and concerned about this child being removed.
This article provides responses from a practice panel on the case of a woman with learning difficulties whose two children were taken into care and adopted, and who is now pregnant and concerned about this child being removed.
Subject terms:
learning disabilities, pregnancy, risk, assessment, case studies;
Children and Youth Services Review, 73, 2017, pp.474-481.
Publisher:
Elsevier
In the UK, child sexual exploitation (CSE) has received considerable attention in the last few years, with evidence pointing to an increased risk for young people with learning disabilities. However, no study has specifically focused on this and little is known about how best to protect, identify or support this group. This paper is based on a UK study which examined the identification of, and support for sexual exploited young people with learning disabilities. Data collection included surveys of all local authorities in the UK and of a sample of services supporting vulnerable or disabled children, in-depth interviews with 34 professional stakeholders and with 27 young people with learning disabilities who were at risk of, or who had experienced CSE. This paper provides an overview of the study and identifies areas for improvement in policy and practice including the need for education, training and awareness raising amongst young people, their families and professionals; tackling social isolation, disempowerment and invisibility of young people with learning disabilities, and the need for full implementation of government guidance with a spotlight on this group of young people.
(Publisher abstract)
In the UK, child sexual exploitation (CSE) has received considerable attention in the last few years, with evidence pointing to an increased risk for young people with learning disabilities. However, no study has specifically focused on this and little is known about how best to protect, identify or support this group. This paper is based on a UK study which examined the identification of, and support for sexual exploited young people with learning disabilities. Data collection included surveys of all local authorities in the UK and of a sample of services supporting vulnerable or disabled children, in-depth interviews with 34 professional stakeholders and with 27 young people with learning disabilities who were at risk of, or who had experienced CSE. This paper provides an overview of the study and identifies areas for improvement in policy and practice including the need for education, training and awareness raising amongst young people, their families and professionals; tackling social isolation, disempowerment and invisibility of young people with learning disabilities, and the need for full implementation of government guidance with a spotlight on this group of young people.
(Publisher abstract)
Subject terms:
young people, learning disabilities, risk, child sexual exploitation, child sexual abuse, surveys;
British Journal of Learning Disabilities, 45(1), 2017, pp.21-31.
Publisher:
Wiley
Background: Information and communication technologies, with the Internet at the forefront, have the potential to enhance the knowledge, service, employment, development and social interactional opportunities available to people with intellectual disabilities. Despite this, people with intellectual disabilities are not accessing the Internet to the same degree as people without intellectual disabilities. Issues of safety, risk and protection online for people with intellectual disabilities have yet to be adequately investigated, and these currently serve as reasons given for hindering people from gaining online access.
Materials and Method: This survey aimed to gauge the views people without intellectual disabilities have of risks and benefits of using the Internet for themselves and for people with intellectual disabilities and to compare self-ratings of risk and benefits to ratings for people with intellectual disabilities.
Results: The survey findings indicate that, with only a small number of exceptions, both the risks and benefits of being online were believed to be greater for people with intellectual disabilities compared with those without intellectual disabilities. Greater use of the Internet was associated with increased perception of benefits to being online for both people with intellectual disabilities and for participants.
Conclusions: Perceptions of increased benefits suggest more needs to be performed to improve online access whilst a perception of increased risk may help to explain the reduced inclusion of people with intellectual disabilities in the online world.
(Publisher abstract)
Background: Information and communication technologies, with the Internet at the forefront, have the potential to enhance the knowledge, service, employment, development and social interactional opportunities available to people with intellectual disabilities. Despite this, people with intellectual disabilities are not accessing the Internet to the same degree as people without intellectual disabilities. Issues of safety, risk and protection online for people with intellectual disabilities have yet to be adequately investigated, and these currently serve as reasons given for hindering people from gaining online access.
Materials and Method: This survey aimed to gauge the views people without intellectual disabilities have of risks and benefits of using the Internet for themselves and for people with intellectual disabilities and to compare self-ratings of risk and benefits to ratings for people with intellectual disabilities.
Results: The survey findings indicate that, with only a small number of exceptions, both the risks and benefits of being online were believed to be greater for people with intellectual disabilities compared with those without intellectual disabilities. Greater use of the Internet was associated with increased perception of benefits to being online for both people with intellectual disabilities and for participants.
Conclusions: Perceptions of increased benefits suggest more needs to be performed to improve online access whilst a perception of increased risk may help to explain the reduced inclusion of people with intellectual disabilities in the online world.
(Publisher abstract)
Subject terms:
risk, learning disabilities, internet, online services, information technology, surveys;
Journal of Applied Research in Intellectual Disabilities, 30(1), 2017, pp.188-197.
Publisher:
Wiley
Background: People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health.
Materials and Methods: The present authors undertook secondary analysis of confidentialised unit records collected in Wave 3 of Understanding Society.
Results: British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR = 1.77, 95% CI (1.25–2.52), P < 0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [GHQ Caseness adjusted OR = 1.06, 95% CI (0.73–1.52), n.s].
Conclusions: The authors' analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalised or vulnerable groups.
(Edited publisher abstract)
Background: People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in mental health may reflect between-group differences in rates of exposure to common social determinants of poorer health.
Materials and Methods: The present authors undertook secondary analysis of confidentialised unit records collected in Wave 3 of Understanding Society.
Results: British adults with intellectual impairments living in general households are at significantly increased risk of potential mental health problems than their non-disabled peers (e.g. GHQ Caseness OR = 1.77, 95% CI (1.25–2.52), P < 0.001). Adjusting for between-group differences in age, gender and indicators of socio-economic position eliminated this increased risk [GHQ Caseness adjusted OR = 1.06, 95% CI (0.73–1.52), n.s].
Conclusions: The authors' analyses are consistent with the hypothesis that the increased risk of poor mental health among people with intellectual impairments may be attributable to their poorer living conditions rather than their intellectual impairments per se. Greater attention should be given to understanding and addressing the impact of exposure to common social determinants of mental health among marginalised or vulnerable groups.
(Edited publisher abstract)
Subject terms:
learning disabilities, mental health problems, risk, standard of living, comparative studies, mental health;