A systematic review of training methods to increase staff's knowledge and implementation of positive behaviour support in residential and day settings for individuals with intellectual and developmental disabilities

Behaviour support plans (BSPs), if accurately implemented, have been found to increase skills and decrease challenging behaviour of individuals with intellectual and developmental disabilities. Training is essential for staff to acquire the skills necessary for accurate implementation. The aim of this systematic literature review was to evaluate procedures used to train staff in Positive Behaviour Support (PBS), on both knowledge of PBS and implementation of BSPs. Systematic searches of 4 databases identified 18 studies as meeting criteria. Findings indicate that description alone was not consistently effective in increasing knowledge and should be used in combination with other training strategies. Staff's implementation of BSPs were increased by different combinations of the following training components: description, feedback, modelling, role-play, monitory incentive, and escape contingency. To identify evidenced based practice when training staff on BSPs, it is necessary to evaluate active and feasible training components from current training models.

Understanding active school travel through the Behavioural Ecological Model

Active school travel (AST) is an important source of physical activity for children and a conceptual understanding of AST is necessary to inform promotion efforts. The aim of this article is to provide a conceptual analysis of AST. All currently identified AST formulations include intra-individual variables which are often recommended as intervention targets. However, existing literature lacks clarity on precisely how these intra-individual variables might shape specific AST interventions. Moreover, evaluative studies of AST interventions typically fail to specify an underpinning theory or model. To address this limitation, the Behavioural Ecological Model (BEM), not previously addressed in AST, is presented to guide this area of research. Based on specific examples, we draw attention to the role of potential antecedents and potential reinforcers of AST, as well as potential reinforcers of motorised travel. Antecedents and reinforcers may help to explain choices of school travel mode, and to inform and increase intervention options to promote AST. Consistent with the BEM, the provision of more immediate consequences, such as fun and material prizes, is an evidence-based strategy for increasing AST which is likely to be low-cost and easier to deliver than alternative interventions. This approach to the study of AST is expected to contribute to similar analyses in this and other areas of behaviour change research, and to a more useful discussion and treatment of theoretical and conceptual behavioural models.

Functional Assessment of Problem Behaviors in Adults with Mental Retardation

Functional assessment has significantly improved the success of behavioral treatment of problem behaviors in adults with mental retardation. Functional assessment methods (i.e., techniques that yield a hypothesis of functional relationships) include direct observation, interviews, and checklists. Functional analysis consists of empirical methods that demonstrate behavioral function in controlled settings. Each method has advantages and limitations that reflect differences in both available resources and individual client characteristics. These methods and issues are reviewed, and future directions for both the research field and the adult population are suggested.

Training laboratory primates – benefits and techniques

Abstract. This review discusses the benefits of training in the effective management of laboratory-housed nonhuman primates, including improved welfare, facilitated husbandry, improved quality of data, and human–animal relationships. Training implies that the animals cooperate in aspects of their own care and is a type of enrichment. Some refined ways of using negative reinforcement are discussed, as well as management perspectives on laboratory primate training. Several approaches to dealing with fear are described: systematic desensitization/counterconditioning (SD/CC) versus combined reinforcement training (NPRT). In addition, a detailed shaping plan covering target training, useful when e.g. moving, weighing, or stationing animals, is presented.

The role of physiological arousal in the management of challenging behaviours in individuals with autistic spectrum disorders

Challenging behaviours restrict opportunities and choices for people with autistic spectrum disorders (ASD) and frequently lead to inappropriate and costly service interventions. Managing challenging behaviours of people with autism is an important area of research. This paper examines some of the evidence for the role of physiological arousal influencing these behaviours. Evidence from the emerging literature about sensory differences is examined. It is proposed that sensory reactivity is associated with hyperarousal; catatonic type behaviours are associated with low levels of reactivity (hypoarousal). A low arousal approach is proposed as a generalised strategy to managing challenging behaviours with ASD. The use of non-contingent reinforcement and antecedent control strategies are recommended for use with challenging behaviours which have a sensory component. Examples are provided to illustrate the approach. The implications of arousal and the use of physical interventions are discussed. It is proposed that arousal is a construct which has significant heuristic value for researchers and practitioners.

Revealing interdyad differences in naturally occurring staff reactions to challenging behaviour of clients with severe or profound intellectual disabilities by means of Clusterwise Hierarchical Classes Analysis (HICLAS)

BACKGROUND

Investigating interdyad (i.e. couples of a client and their usual caregiver) differences in naturally occurring patterns of staff reactions to challenging behaviour (e.g. self-injurious, stereotyped and aggressive/destructive behaviour) of clients with severe or profound intellectual disabilities is important to optimise client-staff interactions. Most studies, however, fail to combine a naturalistic setup with a person-level analysis, in that they do not involve a careful inspection of the interdyad differences and similarities.

METHOD

In this study, the recently proposed Clusterwise Hierarchical Classes Analysis (HICLAS) method is adopted and applied to data of in which video fragments (recorded in a naturalistic setting) of a client showing challenging behaviour and the staff reacting to it were analysed. In a Clusterwise HICLAS analysis, the staff-client dyads are grouped into a number of clusters and the prototypical behaviour-reaction patterns that are specific for each cluster (i.e. interdyad differences and similarities) are revealed.

RESULTS

Clusterwise HICLAS discloses clear interdyad differences (and similarities) in the prototypical patterns of clients' challenging behaviour and the associated staff reactions, complementing and qualifying the results of earlier studies in which only general patterns were disclosed.

CONCLUSIONS

The usefulness and clinical relevance of Clusterwise HICLAS is demonstrated. In particular, Clusterwise HICLAS may capture idiosyncratic aspects of staff-client interactions, which may stimulate direct support workers to adopt person-centred support practices that take the specific abilities of the client into account.

Who's challenging who? Changing attitudes towards those whose behaviour challenges

BACKGROUND

Although staff attitudes towards individuals with intellectual disability (ID) whose behaviour challenges may be an important part of a positive support culture, very little research has focused on the development of training specifically designed to change staff attitudes. Positive contact is hypothesised to be an effective way to change attitudes towards stigmatised groups.

METHODS

We designed and developed a half day training package about the experiences of individuals whose behaviour challenges - Who's Challenging Who (WCW). The WCW package was delivered according to a manual by a trainer with ID and a professional without disability. Seventy-six staff from a variety of organisations participated in one of 10 WCW training sessions and provided data on their attitudes and empathy towards individuals whose behaviour challenges prior to the WCW training and immediately at the end of training. Staff also completed a post-training evaluation questionnaire.

RESULTS

A training package was successfully developed collaboratively with individuals whose behaviour challenges, and received very positive evaluations from staff participants. Short-term positive change was shown for empowerment and similarity attitudes, and staff empathy and self-efficacy. These outcomes were associated with small to moderate effect sizes.

CONCLUSIONS

Meaningful short-term positive staff attitude changes were found and the WCW training model was shown to be feasible. More robust research designs are needed for future evaluation. In addition, the function of an attitude change intervention such as WCW within organisations' training strategies requires further development.

Care staff attributions about challenging behaviors in adults with intellectual disabilities

A number of researchers have explored the attributions that care staff make about challenging behavior. The expectation, based on behavioral and cognitive models, is that these attributions may help predict why staff inadvertently reinforce challenging behavior. Two studies of staff attributions about challenging behavior are reported. In the first, a high level of consistency in attributions across staff was found. In a second quasi-experimental study, staff made attributions about two known clients' behavior. Analysis of these data showed that attributions varied in a manner broadly consistent with the hypothesized functions of the behaviors. The weight of the evidence suggests that staff may be sensitive to the causes of challenging behavior. The practical implications of these data are discussed.

Preschool Teachers’ Perceptions and Reactions to Challenging Classroom Behavior

Awareness of issues of social competence and challenging behavior related to childhood language and communication disorders has been increasing. The purpose of this clinical exchange is to provide speech-language pathologists with basic information on communication disorders and challenging behaviors, as well as with insights into ways to support both students and classroom teachers. To provide effective services to children with language impairments and optimally support classroom staff, speech-language pathologists need to recognize (a) the interdependence of language, communication, social competence, and challenging behaviors; (b) the significance that challenging behaviors can have on evaluations of academic competency; and (c) how teachers in early childhood classrooms perceive and react to challenging behaviors. This clinical exchange provides an overview of the relationship between language, communication, and social competence, and presents preliminary survey research data investigating teachers’ perceptions and reactions to challenging behaviors. Clinical implications are discussed, including considerations for intervention with children who may exhibit challenging behaviors in combination with language disabilities, and the speech-language pathologist’s instrumental role in educating and supporting classroom staff to use communication strategies when managing challenging classroom behaviors.

Mothers' expressed emotion towards children with and without intellectual disabilities

OBJECTIVES

To identify factors associated with maternal expressed emotion (EE) towards their child with intellectual disability (ID).

DESIGN AND METHOD

A total of 33 mothers who had a child with ID and at least one child without disabilities between the ages of 4 and 14 years participated in the study. Mothers completed self-assessment questionnaires which addressed their sense of parenting competence, beliefs about child-rearing practices, and their reports of behavioural and emotional problems of their child with ID. Telephone interviews were conducted to assess maternal EE towards the child with ID and towards a sibling using the Five Minute Speech Sample (FMSS; Magana et al. 1986), and also to assess the adaptive behaviour of the child with ID using the Vineland Adaptive Behaviour Scale (VABS; Sparrow et al. 1984).

RESULTS

Mothers with high EE towards their child with ID were more satisfied with their parenting ability, and their children had more behaviour problems. Analysis of differential maternal parenting, through comparisons of EE towards their two children, showed that mothers were more negative towards their child with ID for all domains of the FMSS except dissatisfaction.

CONCLUSIONS

A small number of factors associated with maternal EE towards children with ID were identified. Differences in maternal EE towards their child with ID and their other child suggest that EE is child-driven rather than a general maternal characteristic. Implications of the data for future research are discussed.

Determinants of negative emotional reactions and causal beliefs about self-injurious behaviour: an experimental study

BACKGROUND

Caregivers' emotional and cognitive reactions to challenging behaviours have been identified as potential determinants of their reinforcing responses towards such behaviours. However, few studies have explored factors affecting caregivers' emotional and cognitive responses to challenging behaviours.

METHODS

Sixty students inexperienced in work with people with challenging behaviours and 60 experienced staff watched one of two carefully matched, acted videotapes depicting self-injury maintained by attention or escape-from-task demands. The participants were also told whether the self-injury depicted typically led to mild or severe consequences for the person filmed. The subjects completed measures of their negative emotional reactions to the self-injury and their behavioural causal beliefs about the behaviour depicted.

RESULTS

Analyses of variance revealed that students reported more negative emotional reactions and were less likely to endorse behavioural causal hypotheses. Those who watched the severe self-injury videotape also reported more negative emotional reactions. Two effects of the behavioural function of the depicted self-injury were also found: (1) attention-maintained self-injury was associated with higher levels of endorsement of behavioural causal hypotheses; and (2) severe attention-maintained self-injury led to the strongest negative emotional reactions, but only from students.

CONCLUSIONS

The effects of experience and behavioural function on emotional reactions and behavioural causal beliefs need to be explored in more detail in future research. If replicated, the present results have significant implications for theory and practice in the remediation of challenging behaviours and the support of care staff.