The Checklist of Challenging Behaviour and its relationship with the Psychopathology Inventory for Mentally Retarded Adults

Evaluation of a Web-Based Training Program for Professional Carers Working With People With Learning Disabilities and Challenging Behavior: A Pilot Study with SSED-Design

The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.

A brief screening instrument for emotionally unstable and dissocial personality disorder in male offenders with intellectual disabilities

Personality disorder is prevalent among offenders with intellectual disabilities (ID), and it is associated with their risk for violence and recurrent offending behaviour. A new staff-rated instrument, the Personality Disorder Characteristics Checklist (PDCC), designed to screen for ICD-10 dissocial and emotionally unstable personality characteristics was evaluated for its reliability and validity, as applied to 129 male forensic patients with ID. Internal consistency and test-retest reliability were very good. Supportive evidence for concurrent and discriminant validity was obtained in conjunction with an established staff-rated instrument, but not for patient self-report measures. Construct validity support was found for the PDCC in association with violent offence and hospital assault history and in significantly accounting for the number of physical assaults in hospital, controlling for multiple covariates. Results for the new measure were favourable in comparison to established instruments. It clinical utility for treatment planning and for the management of risk is discussed.

Scaling methods to measure psychopathology in persons with intellectual disabilities

Psychopathology prior to the last four decades was generally viewed as a set of problems and disorders that did not occur in persons with intellectual disabilities (ID). That notion now seems very antiquated. In no small part, a revolutionary development of scales worldwide has occurred for the assessment of emotional problems in persons with ID. The first standardized test to emerge was the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) in 1984. Since that time, an impressive number of measures of general psychopathology have emerged for adults and children as well as for persons across the full range of levels of ID. The purpose of this review was to provide a description of available measures, to review papers published on these measures, and to discuss emerging trends in test development. The trends in this body of information for enhancing differential diagnosis of psychopathology in persons with ID are discussed.

The relationship between challenging behaviour, burnout and cognitive variables in staff working with people who have intellectual disabilities

BACKGROUND

There is evidence to suggest a relationship between the way in which staff perceive challenging behaviour and burnout in staff working with people with intellectual disabilities (ID) and challenging behaviour. However, the evidence of a direct link is equivocal and it is possible that a number of different variables mediate this relationship. The aim of the study is to confirm whether there is a relationship between challenging behaviour and staff burnout, and in addition, to test whether staff perceptions about challenging behaviour mediate this relationship.

METHOD

Seventy-eight staff completed measures of burnout, challenging behaviour and perceptions about challenging behaviour. The perceptions explored included beliefs about the timeline of behaviour, staff's perception of whether they themselves have control over the behaviour, beliefs about clients' ability to control the behaviour and staff's negative emotional responses.

RESULTS

Significant positive correlations were found between challenging behaviour and burnout, challenging behaviour and cognitive variables, and cognitive variables and burnout. Regression analyses demonstrated that negative emotions mediate the relationship between challenging behaviour and burnout.

CONCLUSIONS

The results show evidence that there is a relationship between challenging behaviour and burnout that is mediated by negative emotion, namely the fear of potential assault.

A study of behaviour profiles among intellectually disabled people in residential care in Hungary

The authors investigated the behavioural dimensions of 269 intellectually disabled (ID) people in residential care in specialized institutions in Tolna county (South-West Hungary) with the aim of screening the frequency and severity of the relevant behavioural symptoms associated with intellectual disability and depending on the level of intellectual impairment. Only 120 residents had an International Classification of Disease (ICD) diagnosis of "mental retardation (MR)" and a valid IQ grading either by means of the Hungarian standard version of the HAWIK or by the coloured Raven test. 4 IQ groups were created: borderline (B), mild (MID), moderate (MOD) and profound (PID) intellectual disability subgroups. The Hungarian pilot version of the Behaviour Problem Inventory (BPI) was used. seventy-two percent of the residents displayed behavioural problems. All scale score means exhibited an enhancing tendency with IQ loss, as both frequency and Seventy increased linearly towards the more severe groups, but significantly only in the category of stereotyped behaviour. The authors focussed on problems of patient recruitment and discussed the measurement of behavioural and other psychiatric symptoms when researchers reported on the increased occurrence of behaviour and psychiatric symptoms in ID populations.

Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service

Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.

Pharmacological management of challenging behavior of individuals with intellectual disability

In many Westernized countries, including Australia, concerns about the use of psychotropic drugs to manage the challenging behavior of individuals with intellectual disability have resulted in the development of legislative and procedural controls. Although these constraints may limit indiscriminate use, employing medication remains a common practice. This study examined information about 873 individuals (566 males, 307 females) who were the subjects of reports to the Intellectual Disability Review Panel in March 2000 concerning the use of chemical restraint. A high proportion of people with intellectual disability were reported to have received drugs for purposes of behavioral restraint. The range of drugs was extensive, although those from the antipsychotic class were the most frequently reported. Many individuals concurrently received more than one type of drug or more than one drug from the same drug class. More males than females and more older than younger individuals were administered medication. A relationship between gender and age was apparent, with younger males but older females dominating. The use of drugs to mange the behavior of people with intellectual disability may at times be warranted. However, it is important that the extent and type of drug use, as well as the characteristics of those who are medicated, be subject to ongoing scrutiny.

Prevalence of psychiatric symptoms in adults with mental retardation and challenging behaviour

The relation between psychiatric symptoms and different types of challenging behaviour in adults with mental retardation was investigated, using an instrument designed for use by non-specialist informants. A sample of 165 persons with mental retardation was surveyed for the presence of psychiatric symptoms, level of mental retardation, and self-injurious and other types of challenging behaviour. Challenging behaviour was associated with increased prevalence of psychiatric symptoms, especially anxiety and psychosis, less with hypomania, and not with depression. No association between anxiety and self-injurious behaviour was found. An association between psychiatric symptoms and challenging behaviour on a group level is an initial step towards understanding causes of challenging behaviour. Issues remain, like how causation takes place on an individual level, and the nature of psychiatric disorders in persons with severe and profound mental retardation.

Behavioural symptoms among people with severe and profound intellectual disabilities: a 26-year follow-up study

BACKGROUND

Very little is known about the natural history of challenging behaviour and psychiatric disorder in people with severe and profound degrees of intellectual disability.

AIMS

To clarify the natural history of challenging behaviour and psychiatric disorder in this population through a longterm prospective cohort study over a 26-year period.

METHOD

One hundred individuals with severe or profound intellectual disability were randomly selected in 1975. Their behaviour was recorded through carer and psychiatrist ratings using the Modified Manifest Abnormality Scale of the Clinical Interview Schedule. The presence and severity of psychiatric disorder were also recorded. The study was repeated in 1981/82 and 1992/93. We repeated the study again in 2001, supplementing the original observational data with the Checklist of Challenging Behaviour.

RESULTS

Behavioural symptomatology is remarkably persistent, particularly stereotypy, emotional abnormalities, eye avoidance and overactivity, although the severity of overall psychiatric disorder does show some abatement through time.

CONCLUSIONS

These findings influence the prospects of success in relocating adults with severe and profound degrees of intellectual disability back into the community.