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

ArticleinJournal of Intellectual Disability Research 55(7):675-98 · March 2011with31 Reads
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.
    • "According to SIGN-50, studies are allocated to one of four categories based on their level of evidence (LE), with LE1 indicating the lowest risk of bias. As there is no checklist for cross-sectional studies, we followed the procedures of De Winter et al. [17] and Van de Wouw et al. [18] and adapted the SIGN methodology checklist for cohort studies in order to enable assessment of cross-sectional studies. Accordingly, the level of evidence of cross-sectional studies was considered to be LE2, and cross-sectional studies without statistical analyses were considered as nonanalytical studies (LE3). "
    [Show abstract] [Hide abstract] ABSTRACT: Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.
    Article · Jul 2016
    • "A clear underlying conceptual framework is needed to identify why challenging behaviours occur. For example, studies has shown that there are relationships between CB and pain, insomnia , urinary incontinence, and hearing loss among people with LD (de Winter, Jansen & Evenhuis, 2011; Findlay, Williams & Scior, 2014). There is a risk that carers underestimate or disbelieve pain and other physical conditions. "
    [Show abstract] [Hide abstract] ABSTRACT: 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.
    Article · Jun 2016
    • "Individuals with intellectual disabilities often engage in one or more forms of repetitive behaviors such as body rocking, hand fl apping, head rolling, object twirling, and echolalia (Bodfi sh, Crawford, Powell, & Parker, 1995 ). These repetitive behaviors are commonly referred to as stereotypy in the research literature on challenging behaviors (De Winter, Jansen, & Evenhuis, 2011 ; Lloyd & Kennedy, 2014 ). Given that stereotypy may take on many forms, Rapp and Vollmer ( 2005 ) proposed three defi ning characteristics to differentiate stereotypy from other forms of challenging behaviors. "
    [Show abstract] [Hide abstract] ABSTRACT: This chapter provides an overview of behavior analytic procedures for assessing and treating stereotypical behavior that is exhibited by individuals diagnosed with autism and intellectual disabilities. First, the chapter begins with a functional definition of motor and vocal stereotypy. Second, the chapter briefly reviews the epidemiology of stereotypy and other repetitive behaviors. Third, the chapter outlines criteria for evidence-based treatments and then describes several antecedent- and consequent-based interventions with strong, moderate, or no evidence in the literature. Fourth, the chapter outlines the application of stimulus control procedures, which are behavioral interventions with emerging empirical support for decreasing stereotypy during instructional periods. Finally, the chapter concludes with an overview of a model for treatment selection and progression.
    Chapter · Jan 2016 · Issues in Mental Health Nursing
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