Challenging behaviours: prevalence and topographies

Lowe, Katherine; Allen, David G.; Jones, Edwin; Brophy, Sam; Moore, Kate; James, Wendy

doi:10.1111/j.1365-2788.2006.00948.x

Cited by 297 publications

(242 citation statements)

References 20 publications

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“…Depending on the definition and methodology, rates have been reported to vary from 5.7 to 17% (7)(8)(9)(10). Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) (11), Cooper et al (12,13) recently found the point prevalence of…”

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confidence: 99%

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

et al. 2009

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Intellectual disability (ID) or mental retardation or learning disability is a lifelong condition included in the group of mental disorders in all the international classification systems. It is a syndrome grouping (meta-syndrome) including a heterogeneous range of clinical conditions characterized by a deficit in cognitive functioning prior to the acquisition of skills through learning (1). Over 30% of people with ID have a comorbid psychiatric disorder, which often has its onset in childhood and persists through adolescence and adulthood (2,3).In spite of this evidence, ID and related conditions are still considered a marginal area of psychiatry. In many countries there is little or no training provision on ID during undergraduate medical training or psychiatric specialization. The World Health Organization (WHO) has recently highlighted the unmet care needs of persons with ID (4). Psychiatrists are the first health professionals in contact with this population group and there is a global gap in training and guidelines on mental health issues related to ID.Within the ID field, the assessment, differential diagnosis and treatment of problem behaviours (PBs) deserve special attention. The rate of PBs in people with ID is high (5) and their presentation is determined by many complex factors. The pathogenic contribution of organic conditions, psychiatric disorders, environmental influences, or a combination of these has to be carefully established for every single case.The prevalence of PBs in people with ID seems to be sufficiently high (5,6) to constitute a major concern in this population. Depending on the definition and methodology, rates have been reported to vary from 5.7 to 17% (7-10). Using the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities (DC-LD) (11), Cooper et al (12,13) aggression and self-injurious behaviour to be 9.8% and 4.9%, respectively, among adults (16 years and over) with ID in a community setting.It has been reported that 20-45% of people with ID are receiving psychotropic medication and 14-30% are receiving psychotropic medication to manage PBs such as aggression or self-injurious behaviours (14,15) in the absence of a diagnosed psychiatric disorder. Examples of psychotropic medications used for adults with ID are antipsychotics, antidepressants, anti-anxiety drugs (benzodiazepines, buspirone, beta-blockers), mood stabilizers (lithium, anticonvulsants), psychostimulants, and opioid antagonists. Spreat et al (16) reported that as many as two thirds of psychotropic medications prescribed to people with ID are antipsychotics.Studies suggest that PBs are not only prevalent but also persistent in people with . Totsika et al (20) found that serious physical attacks, self-injury and stereotypy were the most likely types of PBs to persist over time. It is therefore suggested that it may be necessary to start interventions as early as possible to prevent the behaviours from becoming more serious and to reduce the number of emergent behaviours. It has...

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confidence: 99%

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

et al. 2009

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“…While Lowe et al (2007) deduced that there was veracity in articulating that aggression against others was more prevalent in younger males and level of intellectual disability had no prominent significance. Comparability of elemental correlations of studies focusing on aggression against others can be intricate.…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive behaviour within intellectual disability populations has been widely researched (Wisely et al, 2002;Collins and Cornish, 2002;McClintock et al, 2003;Slevin, 2003;Margari et al, 2005;Lowe et al, 2007;Hassiotis et al, 2008) and is considered to be the main impediment to social integration for this specific population (Crocker et al, 2006). However, barriers exist that impede staff implementing effective behavioural interventions such as the absence of an organisational ethos supporting behaviour supports (Ager and O'May, 2001), the absence of adequate performance management systems for the implementation of behavioural interventions (Reid et al, 2005), negative staff perceptions of aggressive behaviour and behavioural interventions (Ager and O'May, 2001), and the lack of consistency in classifying aggressive behaviour achieved through specific prevalence rates (Crocker et al, 2007).…”

Section: Literature Reviewmentioning

confidence: 99%

Identifying the prevalence of aggressive behaviour reported by Registered Intellectual Disability Nurses in residential intellectual disability services: an Irish perspective

Crotty¹,

Doody

Lyons

2014

Advances in Mental Health and Intellectual Disabilities

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Purpose -Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach -This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs' within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. In total, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings -The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value -The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland.

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“…This multidimensional view can be regarded as a crucial aspect in the evaluation of challenging behaviour and mental health problems in persons with ID, which are quite common as prevalence figures vary from 10% to about 20% for challenging behaviour (Emerson et al, 2001;Lowe 2007;Lundqvist 2013). The risk for developing challenging behaviour is estimated to be three to five times higher for people with ID as compared to the general population (Emerson & Einfeld 2011).…”

Section: Introductionmentioning

confidence: 99%

A study on the usefulness and reliability of the “Scheme of Appraisal of Emotional Development” (SAED) for persons with ID using direct observation in a group-based assessment procedure

Elstner

Diefenbacher

Kirst³

et al. 2016

Research in Developmental Disabilities

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Introduction: Whereas instruments for the assessment of intellectual and social abilities are widely available, instruments for the evaluation of emotional development of persons with intellectual disabilities (ID) are rare. The Scheme of Appraisal of Emotional Development (SAED), an internationally used tool developed by Dosen ( 2005a,b), is one of the latter and is based on interviews with caregivers. The present study aims to investigate the internal consistency and interrater-reliability by changing the interview procedure into a direct observation and evaluation approach by a whole team instead of by one expert. Method:The level of emotional development of 175 patients admitted to a psychiatric inpatient unit specialized in the treatment of adults with ID was evaluated with the SAED by the treatment team after an observation period of up to two weeks. The inter-and intra-raterreliability was assessed by direct observation of the behaviour of an additional 50 patients by two pairs of raters. Results:The internal consistency of the SAED dimensions, once rated by team approach, is excellent, and the reliability measures show also good statistical results. Conclusion and implications:The evaluation of the level of emotional development using the SAED by a group-led and/or direct observational procedure show to be a reliable and useful approach. The group-based procedure yields equal results compared with the usual interview guidelines and might lead to an additional training effect within the respective teams. The rater-reliability measures align with those reported in other studies.

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Challenging behaviours: prevalence and topographies

Cited by 297 publications

References 20 publications

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities

Identifying the prevalence of aggressive behaviour reported by Registered Intellectual Disability Nurses in residential intellectual disability services: an Irish perspective

A study on the usefulness and reliability of the “Scheme of Appraisal of Emotional Development” (SAED) for persons with ID using direct observation in a group-based assessment procedure

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