Attributions of People with Intellectual Disabilities of Their Own or Other Clients’ Challenging Behavior: A Systematic Review of Qualitative Studies

Abstract

Introduction: As opposed to studies focusing on staffs' attributions of challenging behavior (CB), relatively few studies have looked at how people with intellectual disabilities (ID) attribute such behaviors themselves, and a systematic overview is currently lacking. The aim of this review was to synthesize the evidence from qualitative studies on the attributions people with ID have concerning their own or other clients' CB. Methods: A systematic literature search was conducted in Embase, Medline Ovid, Web of science, Cochrane CENTRAL, PsychINFO Ovid, and Google Scholar. Studies were included if they focused on people with ID who report on attributions of their own or other clients' actual CB. The methodological quality of the studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Result: A total of 10 studies were included. Three main types of factors subdivided in 13 sub-types were reported by clients as potential causes of CB: interpersonal factors (1 support staff, 2 other clients, 3 general, 4 life history), environmental factors (1 ward, 2 social exclusion, 3 situational factors) and intrapersonal factors (1 syndrome or diagnosis, 2 medical or physical symptoms, 3 psychological reasons, 4 emotions and feelings, 5 coping, 6 other). Conclusions: This thematic synthesis shows that clients with ID report a diverse range of attributions regarding their own or other clients' CB. This spectrum can be used as a framework for interpreting CB and for the development of appropriate support systems for people with ID demonstrating CB.

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

“…Reports based on checklists completed by families and professional caregivers may vary according to their previous experience and knowledge regarding manifestations of psychiatric disorder in this population (Kildahl et al 2017). In line with previous suggestions (Appleton et al 2019, Valdovinos et al 2019, Helverschou et al 2011b, direct observation by mental health professionals with specific knowledge and experience concerning psychiatric disorder in ASD and ID may thus be particularly important as the diagnostic complexity increases, and was helpful also in the current study. Recent findings suggest that the challenges present in assessment of psychiatric disorder in this population are present also in evaluation of treatment effects (Rysstad et al 2020), and the use of similar, multimodal strategies proved helpful for evaluation in the current case.…”

“…One of the atypical ways symptoms of psychiatric disorder may manifest in individuals with ASD and ID is as "challenging" behaviours, including self-injurious behaviours (SIB) (Rittmannsberger et al 2020, Painter et al 2018, Bitsika et al 2016, Rzepecka et al 2011. "Challenging" behaviours are complex social phenomena developing due to transactional processes between the individual and contextual/social factors (Wolkorte et al 2019, van den Bogaard et al 2019, Cooper 2016, Hemmings 2007, Emerson 2001. Studies investigating the views of people with ASD/ID have reported that a wide range of causes may contribute to these behaviours (van den Bogaard et al 2019), including lack of structure and clarity in their daily lives leading to feelings of fear and restlessness (Wolkorte et al 2019).…”

“…"Challenging" behaviours are complex social phenomena developing due to transactional processes between the individual and contextual/social factors (Wolkorte et al 2019, van den Bogaard et al 2019, Cooper 2016, Hemmings 2007, Emerson 2001. Studies investigating the views of people with ASD/ID have reported that a wide range of causes may contribute to these behaviours (van den Bogaard et al 2019), including lack of structure and clarity in their daily lives leading to feelings of fear and restlessness (Wolkorte et al 2019). However, the relationship between "challenging" behaviours and psychiatric disorder remains poorly understood (Cooper 2016).…”

Impact of the initial response to COVID‐19 on long‐term care for people with intellectual disability: an interrupted time series analysis of incident reports

“…Clients have been found to attribute challenging behaviours to a range of situational and social factors (Van den Bogaard et al . 2019). Their views on the rise in incidents with aggression in response to drastic changes in their situation might therefore be especially informative for understanding the impact of COVID‐19 countermeasures.…”

Stakeholders’ perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study

“…In addition, people with an ID highly value direct support workers' qualities such as respect, honesty, trust, and a caring, nurturing manner (Clarkson et al 2009, Roeleveld et al 2011. People with an ID also indicate that negative interactions with support staff or feeling rejected by support staff may cause challenging behaviors (van den Bogaard et al 2019). This also asks for high quality interactions between client and direct support staff.…”