How service‐users with intellectual disabilities understand challenging behaviour and approaches to managing it

Abstract

Background This study explored understandings that service‐users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well‐being. Methods Eight participants (three female, five male) partook in individual semi‐structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long‐term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day‐to‐day life was perceived to reduce challenging behaviour in the long term. Conclusions Implications for practice are discussed.

Factors facilitating or hindering meaningful staff–client interactions in people with intellectual disabilities and challenging behaviour: A systematic mixed studies review using thematic synthesis

“…Clients’ feelings of safety, security and confidence, which were strengthened by daily routines, facilitated interactions (Antonsson et al, 2008, 2013; Bambara et al, 2001; Nagra et al, 2017). It was important for clients to be able to express their emotions to staff (Antonsson et al, 2013; Nagra et al, 2017) and receive support to regulate (distressing) emotions (Clarke et al, 2019).…”

“…Second, the need for relatedness requires adequate responses to emotional signals and needs. Clients described feeling understood by staff as an important aspect of relationships with staff (Clarke et al, 2019). A failure to understand cues and respond adequately to clients’ emotional needs hinders interactions (Antonsson et al, 2008; Bambara et al, 2001; Embregts, Zijlmans, et al, 2019; Nagra et al, 2017; Zijlmans et al, 2014b).…”

“…Clients should know that staff is there for them, and staff would not leave because of their challenging behaviour (Bambara et al, 2001; Ravoux et al, 2012). Clients emphasized the importance of trust as well, referring to the approachability of staff for advice, guidance and support (Clarke et al, 2019; Olivier‐Pijpers et al, 2020).…”

“…Two recent studies published in 2019 and 2020 included in the present review considered insights from clients (Clarke et al, 2019; Olivier‐Pijpers et al, 2020). Dodevska and Vassos (2013) showed that professionals and clients conceptualize a ‘good’ staff member differently, underpinning the importance of persevering this emerging trend of including clients’ insights in future research into staff–client interactions.…”

Family Involvement in Person-Centered Approaches for People with Intellectual Disabilities and Challenging Behaviors: A Scoping Review

“…It was found in a qualitative study with eight people with intellectual disabilities and challenging behaviors, that positive family relationships could have a positive effect on the behaviors of people with intellectual disabilities. Challenging behaviors decreased when the people with intellectual disabilities experienced a sense of belonging and the opportunity to participate in valued relationship roles rather than feeling that they were being "looked after" (Clarke et al, 2019). Therefore, Clarke et al (2019) stated that maintaining family relationships should be a priority of health care facilities because of their importance to the well-being of people with intellectual disabilities and the management of their challenging behaviors.…”