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Low mood and challenging behaviour in people with severe and profound intellectual disabilities
- Authors:
- HAYES S., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 55(2), February 2011, pp.182-189.
- Publisher:
- Wiley
“Diagnostic overshadowing” has been an obstacle for people with intellectual disabilities (ID) exhibiting symptoms of a mental illness. Progress has been made but there remains a tendency to assume that challenging behaviour stems from the ID rather than being symptomatic of mental illness. This study investigated the relationship between low mood and challenging behaviour in people with severe and profound ID, while controlling for the presence of potentially confounding variables such as diagnosis of autism, physical and sensory problems and ill health. The key workers of 52 people with severe and profound ID, living in residential care in Ireland, completed measures of depression, communication, challenging behaviour and provided information on demographic and health variables. Using the Mood, Interest and Pleasure Questionnaire, a significant difference was found between a ‘low mood’ and ‘normothymic’ group in the reported occurrence of challenging behaviour. This difference remained after confounding variables such as the presence of autism, health and sensory difficulties were controlled. The frequency and severity of challenging behaviour was predicted by measures indicating the presence of low mood. The authors conclude that people with severe and profound ID show clear and measurable signs of low mood, and in this relatively small sample of institutionalised individuals, low mood was associated with challenging behaviour.
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.
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)
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.
Autism in adults: diagnosis and management
- Author:
- NATIONAL COLLABORATING CENTRE FOR MENTAL HEALTH
- Publisher:
- National Institute for Health and Clinical Excellence
- Publication year:
- 2012
- Place of publication:
- London
Clinical guideline which provides best practice advice on the care of adults with autism. The guidance covers the following key areas: general principles of care; identification and assessment; and interventions for autism, challenging behaviour, coexisting mental disorders. Assessment and interventions for families, partners and carers and organisation and delivery of care are also covered. Recommendations for future research include the need for more evidence on the clinical and cost effectiveness of: self-help for anxiety and depression, cognitive behavioural therapy for anxiety disorders and pharmacological treatments for depression in adults with autism. The full guideline, 'Autism: the NICE guideline on recognition, referral, diagnosis and management of adults on the autism spectrum' contains details of the methods and evidence used to develop the guideline.
Autism: recognition, referral, diagnosis and management of adults on the autism spectrum
- Author:
- NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
- Publisher:
- National Institute for Clinical Excellence
- Publication year:
- 2012
- Pagination:
- 57p.
- Place of publication:
- Manchester
This NICE Guideline offers best practice advice on the care of adults with autism. It covers the care provided by primary, community, secondary, tertiary and other health and social care professionals who have direct contact with, and make decisions concerning the care of, adults with autism. The term autism is used generically to cover all autism spectrum conditions. With an emphasis on person-centred care, the guidance covers: identification and assessment; correct interventions and monitoring their use, interventions for challenging behaviour, managing coexisting mental disorders, assessment and interventions for families, partners and carers; and the organisation and delivery of care. Research recommendations are also discussed.
Escalation/de-escalation patterns of behavioural symptoms of persons with dementia
- Authors:
- WOODS D. L., RAPP C. G., BECK C.
- Journal article citation:
- Aging and Mental Health, 8(2), March 2004, pp.126-132.
- Publisher:
- Taylor and Francis
Behavioural and psychological symptoms of dementia (BPSD) may be framed within the Needs Driven Dementia-Compromised Behavior (NBD) Model. Current literature suggests that BPSD may escalate. Several researchers have described a sequence of behavioural escalation that has a clear starting point and ending point. This 'ideal' or concatenated sequence is used to explain behavior that begins with relatively calm behaviour and progresses through a prescribed sequence of behaviours that end in violence. This article presents two studies, a descriptive study and an intervention study that examine the escalation and de-escalation patterns of BPSD. Results of the descriptive study indicate a dominant pattern of agitation, aggression, and agitation while results of the intervention study, using sequential analysis indicate persistence of behavior from one 20-minute period to another. The persistence of vocalization at intensity level 2 changed from pre-intervention (mean conditional probability 29%) to post-intervention (mean conditional probability 13%). Taken together these studies shed light on the pattern of escalation and de-escalation of BPSD and suggest an intervention to alter behaviour persistence. This article discusses methodological challenges of measuring the escalation and de-escalation of BPSD and offers suggestions for analysis and design such as time series and sequential analysis.