Skip to main content Accessibility help
×
×
Home

Interventions for challenging behaviour in intellectual disability

  • Afia Ali, Jessica Blickwedel and Angela Hassiotis

Summary

Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.

LEARNING OBJECTIVES

  1. Understand the aetiological basis of challenging behaviour.
  2. Understand the role of functional analysis.
  3. Appreciate the evidence base in relation to the psychological and pharmacological treatment of challenging behaviour.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Interventions for challenging behaviour in intellectual disability
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Interventions for challenging behaviour in intellectual disability
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Interventions for challenging behaviour in intellectual disability
      Available formats
      ×

Copyright

Corresponding author

Dr Afia Ali, Mental Health Sciences Unit, University College London, 2nd Floor, Charles Bell House, 67–73 Riding House, London W1W7EY, UK. Email: afia.ali@ucl.ac.uk

Footnotes

Hide All

Declaration of Interest

A.A. was Trainee Editor on Advances in Psychiatric Treatment when this article was written. She took no part in the decision to publish. A.H. is the chief investigator and J.B. a research assistant on a multicentre trial of positive behavioural support for people with intellectual disability presenting with challenging behaviour. The study is being funded by the National Institute for Health Research Health Technology Assessment Programme.

Footnotes

References

Hide All
Allen, D, James, W, Evans, J et al (2005) Positive behavioural support: definition, current status and future directions. Tizard Learning Disability Review, 10 (2): 411.
Berney, TP (2000) Autism – an evolving concept. British Journal of Psychiatry, 176: 20–5.
Bijou, SW, Baer, DM (1978) Behavior Analysis of Child Development Prentice-Hall.
Bishop, S, Lau, M, Shapiro, S et al (2004) Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11: 230–41.
Bradshaw, J, McGill, P, Stretton, R et al (2004) Implementation and evaluation of active support. Journal of Applied Research in Intellectual Disabilities, 17: 139–48.
Brylewski, J, Duggan, L (2004) Antipsychotic medication for challenging behaviour in people with learning disability (review). Cochrane Database of Systematic Reviews, issue 3: CD000377.
Carr, EG, Horner, RH, Turnbull, AP et al (1999) Positive Behavior Support for People with Developmental Disabilities: A Research Synthesis. American Association on Mental Retardation.
Carr, EG, Dunlap, G, Horner, RH et al (2002) Positive behavior support: evolution of an applied science. Journal of Positive Behavior Interventions, 4: 416.
Carter, M, Driscoll, C (2007) A conceptual examination of setting events. Educational Psychology, 27: 655–73.
Commission of Social Care Inspection, Healthcare Commission, Mental Health Act Commission (2009) Commissioning Services and Support for People with Learning Disabilities and Complex Needs: National Report of Joint Review. Commission of Social Care Inspection.
Cooper, SA, Smiley, E, Allan, LM et al (2009a) Adults with intellectual disabilities: prevalence, incidence and remission of self-injurious behaviour, and related factors. Journal of Intellectual Disability Research, 53: 200–16.
Cooper, SA, Smiley, E, Jackson, A et al (2009b) Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. Journal of Intellectual Disability Research, 53: 217–32.
Craft, M, Ismail, IA, Krishnamurti, D et al (1987) Lithium in the treatment of aggression in mentally handicapped patients: a double-blind trial. British Journal of Psychiatry, 150: 685–9.
Crossley, R, Withers, P (2009) Antipsychotic medication and people with intellectual disabilities: their knowledge and experiences. Journal of Applied Research in Intellectual Disabilities, 22: 7786.
Deb, S (2007a) The role of medication in the management of behaviour problems in people with learning disabilities. Advances in Mental Health and Learning Disabilities, 1: 2631.
Deb, S, Unwin, G (2007b) Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature. Current Opinion in Psychiatry, 20: 461–6.
Deb, S, Sohanpal, SK, Soni, R et al (2007c) The effectiveness of antipsychotic medication in the management of behaviour problems in adults with intellectual disabilities. Journal of Intellectual Disability Research, 51: 766–77.
Department of Health (2007) Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs. TSO (The Stationery Office).
Department of Health (2012) Transforming Care: A National Response to Winterbourne View Hospital. Department of Health Review: Final Report. Department of Health.
De Winter, CF, Jansen, AA, Evenhuis, HM (2011) Physical conditions and challenging behaviour in people with intellectual disability: a systematic review. Journal of Intellectual Disability Research, 55: 675–98.
Dodd, P, Dowling, S, Hollins, S (2005) A review of the emotional, psychiatric and behavioural responses to bereavement in people with intellectual disabilities. Journal of Intellectual Disability Research, 49: 537–43.
Durand, VM, Crimmins, DB (1992) The Motivation Assessment Scale (MAS) Administration Guide. Monaco & Associates.
Emerson, C (1995) Challenging Behaviour: Analysis and Intervention in People with Learning Difficulties. Cambridge University Press.
Emerson, E, Kiernan, C, Alborz, A et al (2001a) The prevalence of challenging behaviours: a total population study. Research in Developmental Disabilities, 22: 7793.
Emerson, E, Einfield, S (2001b) Challenging Behaviour: Analysis and Intervention in People with Learning Difficulties (3rd edn). Cambridge University Press.
Esbenson, AJ, Benson, BA (2006) A prospective analysis of life events, problem behaviours and depression in adults with intellectual disability. Journal of Intellectual Disability Research, 50: 248–58.
Fox, L, Dunlap, G, Buschbacher, P (2000) Understanding and intervening with children's challenging behavior: a comprehensive approach. In Autism Spectrum Disorders: A Transactional Developmental Perspective (eds Wetherby, AM, Prizant, BM) 307–31. Brookes Publishing.
Gagiano, C, Read, S, Thorpe, L et al (2005) Short- and long-term efficacy and safety of risperidone in adults with disruptive behavior disorders. Psychopharmacology 179: 629–36.
Grey, IM, Hastings, RP (2005) Evidence-based practices in intellectual disability and behaviour disorders. Current Opinion in Psychiatry, 18: 469–75.
Hanley, GP, Iwata, BA, McCord, BE (2003) Functional analysis of problem behavior: a review. Journal of Applied Behavior Analysis, 36: 147–85.
Harper, S, Webb, T, Rayner, K (2013) The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review. Behavior Modification, 37: 431–53.
Hassiotis, AA, Hall, I (2008) Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities. Cochrane Database of Systematic Reviews, issue 3: CD003406.
Hassiotis, A, Robotham, D, Canagasabey, A et al (2009) Randomized, single-blind, controlled trial of a specialist behaviour therapy team for challenging behaviour in adults with intellectual disabilities. American Journal of Psychiatry, 166: 1278–85.
Hassiotis, A, Canagasabey, A, Robotham, D et al (2011) Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes. British Journal of Psychiatry, 198: 490–1.
Jones, E, Felce, D, Lowe, K et al (2001) Evaluation of the dissemination of active support training and training trainers. Journal of Applied Research in Intellectual Disabilities, 14: 7999.
Jones, RM, Arlidge, J, Gillham, R et al (2011) Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis. British Journal of Psychiatry, 198: 93–8.
LaVigna, GW, Willis, TJ (2012) The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications. Journal of Intellectual & Developmental Disability, 37: 185–95.
Lowe, K, Allen, D, Jones, E (2007) Challenging behaviours: prevalence and topographies. Journal of Intellectual Disability Research, 51: 625–36.
McClintock, K, Hall, S, Oliver, C (2003) Risk markers associated with challenging behaviours in people with developmental disabilities: a meta-analytic study. Journal of Intellectual Disabilities Research, 47: 405–16.
McDougle, CJ, Scahill, L, Aman, MG et al (2005) Risperidone for the core symptom domains of autism: results from the study by the Autism Network of the Research Units on Pediatric Psychopharmacology. American Journal of Psychiatry, 162: 1142–8.
Moss, S (1999) Assessment and conceptual issues. In Psychiatric and Behavioural Disorders in Development Disabilities and Mental Retardation (ed Bouras, N) 1837. Cambridge University Press.
Moss, S, Emerson, E, Kiernan, C et al (2000) Psychiatric symptoms in adults with learning disability and challenging behaviour. British Journal of Psychiatry, 177: 452–6.
National Collaborating Centre for Mental Health (2012) Autism: The NICE Guideline on Recognition, Referral, Diagnosis and Management of Adults on the Autism Spectrum (National Clinical Guideline Number 142). British Psychological Society & Royal College of Psychiatrists.
National Collaborating Centre for Mental Health (2013) Autism: The Management and Support of Children and Young People on the Autism Spectrum (National Clinical Guideline Number 170). NICE.
Oliver-Africano, P, Murphy, D, Tyrer, P (2009) Aggressive behaviour in adults with intellectual disability: defining the role of drug treatment. CNS Drugs, 23: 903–13.
O'Neill, R, Horner, R, Albin, R et al (1997) Functional Assessment and Programme Development for Problem Behaviour: A Practical Handbook. Brooks/Cole Publishing.
Palucka, AM, Nyhus, N, Lunsky, Y (2003) Aggression as a symptom of mood destabilization in pervasive developmental disorders. Journal on Developmental Disabilities, 10: 101–5.
Paton, C, Flynn, A, Shingleton-Smith, A et al (2011) Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. Journal of Intellectual Disability Research, 55: 665–74.
Poppes, P, van der Putten, AJJ, Vlaskamp, C (2010) Frequency and severity of challenging behaviour in people with profound intellectual disability and multiple disabilities. Research in Developmental Disabilities, 31: 1269–75.
Reiss, S, Levitan, G, Szysko, J (1982) Emotional disturbance and mental retardation: diagnostic overshadowing. American Journal of Mental Deficiency, 86: 567–74.
Royal College of Psychiatrists (2007) Challenging Behaviour: A Unified Approach (College Report CR144). Royal College of Psychiatrists.
Sohanpal, SK, Deb, S, Thomas, C et al (2007) The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research, 51: 750–65.
Stancliffe, RJ, Jones, E, Mansell, J et al (2008) Active support: a critical review and commentary. Journal of Intellectual and Developmental Disability, 33: 196214.
Thakker, Y, Bamidele, K, Ali, A et al (2012) Mental health and challenging behaviour: an overview of research and practice. Advances in Mental Health and Intellectual Disabilities, 6: 249–58.
Toogood, S, Drury, G, Gilsenan, K et al (2009) Establishing a context to reduce challenging behaviour using procedures from active support: a clinical case example. Tizard Learning Disability Review, 14: 2936.
Tyrer, SP, Walsh, F, Edwards, DE et al (1984) Factors associated with a good response to lithium in aggressive mentally-handicapped subjects. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 8: 751–5.
Tyrer, P, Bajaj, P (2005) Nidotherapy: making the environment do the therapeutic work. Advances in Psychiatric Treatment, 11: 232–8.
Tyrer, P, Kramo, K (2007) Nidotherapy in practice. Journal of Mental Health, 16: 117–29.
Tyrer, P, Oliver-Africano, P, Romeo, R et al (2009) Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomized controlled trial (NACHBID). Health Technology Assessment, 13 (21): 154.
Unwin, GL, Deb, S (2008) The use of medication for the management of behavior problems among adults with intellectual disability: a clinician's consensus survey. American Journal on Mental Retardation, 113: 1931.
Unwin, GL, Deb, S (2011) Efficacy of atypical antipsychotic medication in the management of behaviour problems in children with intellectual disabilities and borderline intelligence: a systematic review. Research in Developmental Disabilities, 32: 2121–33.
Vissers, LE, De Vries, BB, Veltman, JA (2010) Genomic microarrays in mental retardation: from copy number variation to gene, from research to diagnosis. Journal of Medical Genetics, 47: 289–98.
Willner, P, Rose, J, Jahoda, A et al (2013) A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities. Health Technology Assessment, 17 (21): 1173.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Interventions for challenging behaviour in intellectual disability

  • Afia Ali, Jessica Blickwedel and Angela Hassiotis
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *