Interventions for challenging behaviour in intellectual disability

Abstract

articleChallenging behaviour in individuals with intellectual disability is a complex but common problem that can present diagnostic and management challenges for healthcare professionals. All behaviour serves a purpose, has an origin and meaning, and is therefore produced by an interaction between an individual and their environment. Challenging behaviour is a socially constructed, dynamic concept in that for a displayed behaviour to be considered challenging another person will have interpreted it as being dangerous, frightening, distressing or annoying (Royal College of Psychiatrists 2007). Consequently, what is defined as challenging may vary across cultures or settings.Clinically, challenging behaviour refers to persistent and pervasive maladaptive behaviour(s) that has a significant adverse effect on the quality of life and/or health and safety of the individual or others. The term can include a range of behaviours, for example physical aggression towards objects or people, self-injury, sexually inappropriate behaviour, offending behaviour (such as arson or stealing), mannerisms or rituals (Royal College of Psychiatrists 2007). If the behaviour threatens the quality of life or physical safety of others, it can result in the individual's exclusion from services or community activities or provoke restrictive and aversive responses that may be socially or morally unacceptable. Hence, trying to understand and, where appropriate, reduce the occurrence of challenging behaviour is of utmost importance. Challenging behaviour can be an attempt to communicate unmet needs, so strategies that are proactive and flexible in addressing these should be put in place, positive behavioural development should be promoted and the response of professionals and carers to challenging behaviour should be socially enabling rather than restricting (Royal College of Psychiatrists 2007). EpidemiologyReported prevalence of challenging behaviour in adults with intellectual disability varies depending on the definition used for ascertainment, study methodology, settings and populations. It has previously been reported to range between 6.1% in the community and 40% in long-stay hospitals (Emerson 1995). In the total intellectual disability population the incidence of 'serious challenging behaviour' was found to be around 10% (Lowe 2007) and that of any type of challenging behaviour was 10-15% (Emerson 2001a). A community-based epidemiological study found a prevalence of 4.9% for self-injurious behaviour (Cooper 2009a) and of 9.8% for aggression (Cooper 2009b). Challenging behaviour appears to be even more pervasive in individuals with profound intellectual disability and multiple disabilities, with a prevalence of 82% for self-injurious and stereotypical behaviour and 45% for aggressive/destructive behaviour (Poppes 2010).In a meta-analytic study of markers of challenging behaviour in people with intellectual Interventions for challenging behaviour in intellectual disabilityAfia Ali, Jessica Blickwedel & Angela Hassiotis SummAryChallengin...

Use of positive behaviour support plan for challenging behaviour in autism

“…Challenging behaviour is a social construct: for a behaviour to be categorised as challenging those who come into contact with an individual displaying a particular behaviour must feel that the behaviour is dangerous, frightening, distressing or annoying 5 . For a behaviour to be defined as challenging it must threaten the quality of life and/or the physical safety of the individual or others and the behaviour will likely lead to an individual being excluded from services and/or having restrictive or aversive responses imposed upon them 4,5 . Examples of behaviours that may be considered challenging include self‐injury, sexually inappropriate behaviour, physical aggression and destruction of property 4 .…”

“…For a behaviour to be defined as challenging it must threaten the quality of life and/or the physical safety of the individual or others and the behaviour will likely lead to an individual being excluded from services and/or having restrictive or aversive responses imposed upon them 4,5 . Examples of behaviours that may be considered challenging include self‐injury, sexually inappropriate behaviour, physical aggression and destruction of property 4 . Dynamic management strategies should be utilised in order to manage challenging behaviours with an emphasis on psychological and environmental interventions 5…”

“…ASD affects approximately one third of individuals with learning disability (LD), with greater prevalence in individuals with severe or profound forms of LD 2 . Challenging behaviour can often present in individuals with LD but in patients with LD and a diagnosis of ASD this can be further compounded making challenging behaviours more likely to present as aggression, self‐injury and disruption to the environment 4 …”

A randomised controlled trial on evaluation of the clinical efficacy of massage therapy in a multisensory environment for residents with severe and profound intellectual disabilities: a pilot study

“…From the observation data, it was found that the frequency and severity of challenging behaviour steadily increased in control group, although it was not statistically significant, indicating that manipulation of environmental activity could influence the exhibition of challenging behaviour (Ali et al ).…”

Development and Introduction of “Communication Passport” in an Adult Inpatient Psychiatric Unit for Persons With Intellectual Disabilities: A Brief Report from Singapore

“…Around 10–15% of people with intellectual disabilities have challenging behaviors ranging from aggressive to self‐injurious behaviors (Emerson et al, ). Challenging behaviors may be the result of difficulties in expressing their needs or dissatisfaction (Ali, Blickwedel, & Hassiotis, ). This is often compounded by difficulties in members of staff working with them often lacking access to information about the patient's care needs and communication styles (Hemsley & Balandin, ).…”