Physical conditions and challenging behaviour in people with intellectual disability: A systematic review

Reinaerde, Organisation for People with Intellectual Disability, Den Dolder, the Netherlands.
Journal of Intellectual Disability Research (Impact Factor: 2.41). 03/2011; 55(7):675-98. DOI: 10.1111/j.1365-2788.2011.01390.x
Source: PubMed


Challenging behaviour is a major problem among people with intellectual disabilities. Physical factors may be an important cause. The aim of the present systematic review was to determine the physical conditions associated with challenging behaviour.
A literature search was conducted in PubMed and the Cochrane systematic review database for empirical studies published between 1990 and 2008. The quality of all the studies that met the inclusion criteria was assessed using the SIGN-50 methodology checklists.
The search identified 45 studies, which looked at general medical conditions, motor impairment, epilepsy, sensory impairment, gastrointestinal disease, sleep disorders, dementia and others. There were four high-quality observational studies, seven well-conducted observational studies, 21 observational studies of low methodological quality and 13 non-analytical studies. There were significant and independent associations between challenging behaviours and urinary incontinence, pain related to cerebral palsy and chronic sleep problems, and between self-injurious behaviour and visual impairment. No association was found with hearing impairment, bowel incontinence, mobility impairment or epilepsy. Many other physical conditions were not addressed at all.
Medical conditions can play a role in challenging behaviour, and this should be evaluated in the clinical setting. So far, the level of evidence is generally low, and longitudinal studies are completely lacking. We recommend a systematic approach to research examining the role of physical conditions in challenging behaviour, the ultimate aim being to establish a basis for the development of clinical guidelines.

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    • "which specifically mentioned methodologies for the potential inclusion of additional languages included the following: translation into English if required (Beavis et al. 2007a,b); inclusion criteria of English abstract but any language full text (Deb et al. 2008; Einfeld et al. 2011; Unwin & Deb 2011); searches of Latin American and Caribbean Health Science Literature (LI-LACS) carried out in Spanish and Portuguese, and Scandinavian databases searched using appropriate languages (Montgomery et al. 2008; Mayo-Wilson et al. 2008a,b) potential inclusion of studies in Dutch and German (Courtenay et al. 2010; Haveman et al. 2010; Strydom et al. 2010; de Winter et al. 2011); Dutch (van de Wouw et al. 2012); Chinese (Chan et al. 2010); French (Cleaver et al. 2009); and Portuguese, Spanish, French or German (Molina et al. 2011). However, it is not possible to comment on the extent to which reviews actually included studies published in languages other than English. "
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