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To ascertain whether young people with dystonia are more likely than the general population to have mental health and/or behavioural difficulties, and to explore factors that may contribute to these difficulties.Using a quasi-experimental design, 50 young people with dystonia aged 7-17 and their carers were recruited from the Evelina London Children's Hospital. Young people completed the Beck Youth Inventories and the Strengths and Difficulties Questionnaire. Carers completed the Strengths and Difficulties Questionnaire-Parent version and the Paediatric Pain Profile. Important medical factors, such as age of onset, motor severity and manual function were obtained from medical records.One sample z tests showed young people with dystonia self-reported significantly higher levels of anxiety (p .001) and prosocial difficulties (p .01), with 48% experiencing clinically significant anxiety levels. They experienced significantly lower levels of anger, disruptive behaviour and conduct problems (all p ≤ .01). Carers reported significantly higher rates of emotional problems, hyperactivity and peer problems, and significantly lower prosocial behaviours (all p ≤ .01). Pearson's correlation coefficients showed lower levels of self-esteem were related to higher levels of anxiety (p = .015). High levels of pain were related to parent-rated conduct problems (p = .004). Age of dystonia onset and motor severity did not correlate with any of the psychological or behavioural measures.Our study suggests high rates of anxiety and behaviours that challenge in children with dystonia. Screening in movement clinics would be helpful in early identification and signposting for support.

Purpose This paper aims to provide a commentary on the article “Teaching behavioural expectations to secondary age students with intellectual disabilities attending a special school”. Design/methodology/approach The impact on teachers who deal with high levels of behaviours that challenge is explored. Findings The article highlights the importance of proactive, preventative strategies for behaviour management and the need for staff training and support. Originality/value Teachers working with pupils who engage in high levels of behaviours that challenge need training and support.

Purpose School-wide positive behaviour support (SWPBS) is a proactive behavioural support system that fosters behaviour change in individuals in a school setting. This article aims to present a case example of teaching and reinforcing behavioural expectations in a special school. Design/methodology/approach This case study reflects different steps and materials used before and during the intervention in a special education school with 61 secondary students with intellectual disabilities. An AB design (A – baseline; B – intervention) was used to collect and analyze data. Findings Results suggest that teaching behavioural expectations as a universal measure may be feasible and positively impact school climate. Suggestions and recommendations for implementing SWPBS within a school are provided. Originality/value This case study provides a step-by-step guide illustrating the process of teaching and reinforcing behavioural playground expectations to young adults with intellectual disabilities attending a special school.

The new Dutch Care and Coercion Act aims to better regulate the use of psychotropic drugs for challenging behaviour in people with an intellectual disability. This study explores experiences of intellectual disability physicians (IDPs) in prescribing psychotropic drugs and investigates how the Act and the new multidisciplinary guideline on challenging behaviour affects their practice. A qualitative study was conducted, consisting of nine semi-structured in-depth interviews with IDPs, followed by a thematic analysis. It was found that IDPs experienced the new Act and guideline as supportive of their work as guardians of the appropriate use of psychotropic drugs. The multidisciplinary character of the guideline was experienced positively. However, IDPs are faced with organisational barriers and time constraints, as such, they question the feasibility of implementing the Act. Based on these findings, it can be concluded that the Care and Coercion Act may support the existing shift towards the appropriate use of psychotropic drugs if required conditions can be met.

Purpose A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events. Design/methodology/approach Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis. Findings The key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”. Originality/value Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development.

The Pyramid Model (PM) is an evidence-based, early educational framework designed to promote all young children’s social-emotional-behavioural (SEB) learning. The tiered PM early education practice framework, developed in North America, embeds strategies for children with exceptional needs naturally and coherently integrates apparently divergent approaches to promoting young children’s SEB skills. Responsive teaching, which is fundamental to early education practice, is shown to link with positive behaviour support practices by means of incidental and planned intentional teaching. These early education PM practices are intended to promote children’s SEB skills when used together purposefully, consistently, and intensively. The PM’s potential application in Australia was investigated with 4–5-year-olds in 4 Victorian preschools. Quantitative data from the study suggested that after training and subsequent coaching in the PM, there was significant change in intervention educators’ behaviour, which was independently observed and rated using the Teaching Pyramid Observation Tool. Concurrently, the SEB skills of the children in the intervention groups were shown to have developed at a significantly greater rate than the children in the contrast groups as assessed using the Social Skills Improvement System Rating Scales.

Purpose Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

A pilot feasibility study which aims to determine the feasibility and acceptability of a clinical behaviour checklist. The checklist identifies a number of potential causes of behaviours that challenge; namely pain/discomfort, sensory problems/sensitivity, anxiety, low mood, sleep, emotional outbursts, impulsivity, insistence on sameness, social differences. The aim is that the checklist will ensure that these factors are routinely considered.

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.

Purpose Review of antipsychotic prescribing practices, rationale and follow-up using an internationally standardized audit can be an effective tool to encourage and monitor best practices. The purpose of this study is to audit the current prescribing pattern for people with intellectual disabilities and challenging behaviours in Qatar. Design/methodology/approach This study was based on the challenging behaviour management guidelines recommended by the Royal College of Psychiatrists. All current electronic medical records in the Mental Health Service-Hamad Medical Corporation were examined to identify patients with intellectual disabilities who received antipsychotics for challenging behaviour. Demographic variables, such as age, sex and nationality, were collected. In addition, details of psychiatric diagnoses, prescribed psychotropic medications and diagnoses of epilepsy were also collected. For patients who were prescribed antipsychotic medication, the clinical rationale for such medication was collected along with evidence of side effect monitoring to allow performance against the audit standards to be measured. Findings This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The results of this study regarding the pattern of prescribing practices for patients with intellectual disability and challenging behaviour reflect the limitation in knowledge and experience among non-specialist practitioners within mental health service. The result may be helpful to support the development of specialist service provision to improve the care for such vulnerable group. The result may also help other medical centres and clinicians by providing an improved understanding of possible deviations from the best medical practices. Originality/value This is the first audit on prescribing practices in people with intellectual disability and challenging behaviour in the state of Qatar. The study is also noteworthy as, to the best of the authors’ knowledge, it is one of only a few studies on antipsychotic prescribing for patients with intellectual disability and challenging behaviour in the Middle East; therefore, it will be useful in raising awareness and promoting the best practices in the Middle East region. This study is also among the first few studies that were designed based on the four audit standards by the Royal College of Psychiatrists in this area.

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

Challenging behaviour is a problematic issue for students with intellectual disability, including those in special education settings. While there is a need to address challenging behaviour in thes...

Inclusion regarding challenging behaviour is one of the most demanding challenges for teachers. How schools succeed with inclusion regarding challenging behaviour can therefore be a good indicator ...

Background Nearly 60,000 people applied for asylum in the Netherland in 2015, confronting the governmental structures and services with great administrative, logistical and service provision challenges. Refugee children’s psychosocial needs and wellbeing are often overlooked, and post-migration support is of pivotal importance. Methods An easy accessible movement–based psychosocial intervention, called TeamUp, was developed for children aged 6–17 living in refugee reception centres. A mixed-method process evaluation was conducted of (1) implementation process, assessing attendance (n = 2183 children, and n = 209 children); (2) implementation quality, using structured observations at two time points to evaluate facilitator’s (2a) individual-level fidelity (n = 81 facilitators); (2b) team-level fidelity (n = 22 teams); (2c) facilitators’ competencies (n = 81); (2d) trainee perceived self-efficacy pre-post training (n = 73); and (3) perceptions on implementation and outcomes, employing a survey (n = 99), focus group discussions and key informant interviews with children (n = 94), facilitators (n = 24) and reception centre staff (n = 10). Results Attendance lists showed a mean of 8.5 children per session, and children attending 31.3% of sessions. Structured observations demonstrated 49.2% and 58.2% individual-level fidelity, 72.5% and 73.0% team-level fidelity, and 82.9% and 88.4% adequacy in competencies, each at T1 and T2 respectively. The main reported challenges included managing children’s energy regulation (e.g. offering settling moments) and challenging behaviour. Training participation significantly improved perceived self-efficacy for trainees. The facilitator survey demonstrated on average, high satisfaction and self-efficacy, low experienced burden, and high perceived capacity-building support. Qualitatively, TeamUp was positively perceived by all stakeholders and was regarded as contributing to children’s psychosocial outcomes. Conclusion (1) Attendance and group size were lower than expected. (2) The intervention’s facilitator fidelity ranged from moderate to adequate—exhibiting a need for specific fidelity and capacity strengthening—while facilitator competencies were high. Trainee’s perceived self-efficacy improved significantly following a 2-day training. (3) Facilitators expressed high levels of satisfaction, self-efficacy and support, and low burden. The intervention was positively perceived by all stakeholders and to have a positive impact on children’s psychosocial learning and wellbeing.

Purpose The purpose of this paper is to outline the development and piloting of a training intervention for social care staff that uses a capable environments framework to improve the quality of staff support. Design/methodology/approach A single case study was used to evaluate changes in the quality of staff support and in levels of engagement and challenging behaviour for one of the individuals supported. Findings The case study demonstrates the usefulness of the capable environments framework as a model for training and development of support planning. Staff provided more positive interaction and support to the individual, who displayed increased participation in activities and reductions in the occurrence and episodic severity of challenging behaviour. Originality/value Capable environments is a systematic, theoretically-driven approach, which is focussed on the quality of support design and provision for people with intellectual disability. The use of such a framework as an intervention assists staff in the provision of effective personalised supports, a foundation for positive behaviour support.

The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of ‘restrictive practices’ across all sectors of health care, including the difference between ‘restrictive practices’ (such as attitudes of control, limit setting and unnecessary ward rules) and ‘restrictive interventions’ (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.

Purpose This paper aims to improve community care for people with intellectual disabilities (ID) and/or autism. Lack of coordination between agencies leads to children and young people with the most complex needs falling between services. The North West Operational Delivery Network (ODN) for learning disability and autism set out to develop a model of care for mental health services for children and young people with ID and/or autism in North West England that would improve coordination between services and lead to better community care. Design/methodology/approach The ODN held a series of good practice events and consultations with stakeholders in North West England to look at gaps in service provision, national guidelines and agree on a pathway for services. Findings The ODN decided to use the THRIVE framework as the basis for a specific model of care. Interventions were mapped against the THRIVE groupings, including pathways and team specifications for assessment and support for children with autism, and models for child and adolescent mental health service support for ID and/or autism, for keeping children and young people with behaviour that challenges in the community and transition. Originality/value This model aims to provide the North West England region with a clear multi-agency approach for supporting the needs of this population and supports multi-agency commissioning, gap analysis, earlier intervention and improving health outcomes for this population.

Positive behaviour support is used by staff to help people with different disabilities, but we do not know what helps staff to keep using positive behaviour support. We looked at all the reports that people have written about using positive behaviour support to find out what helps staff to keep using it. We used a special way of putting everything together and found groups of important things to do with positive behaviour support, the people who use it, and things happening around them. These things can help staff use positive behaviour support better and for longer. Abstract: Background It is necessary to understand which variables successfully contribute to the adoption of positive behaviour support (PBS) in disability services if people with disability are to experience meaningful outcomes. Methods A systematic review of the disability support literature was undertaken, and meta-aggregation was used to synthesise the findings. The study applies ENTREQ statement criteria, and diffusion of innovations theory was used to analyse and interpret the results. Results Twenty-seven papers were included in the analysis, from which over 300 findings were extracted. Forty-one aggregated findings generated a final set of 26 principles which informed the development of a conceptual framework for the adoption of PBS in disability services. Conclusion The conceptual framework and supporting principles will assist those interested in introducing PBS into disability services for successful adoption and are applicable to researchers, managers, and practitioners alike. Recommendations are made to expand research on the application of PBS in specific disability contexts and to broaden the application of PBS beyond challenging behaviour.

Background: Challenging Behaviour (CB) occurs in up to 80% of nursing home residents with dementia. Identifying stressors causing CB is difficult (as residents themselves cannot indicate what is experienced as stressful), thereby hampering the psychosocial approach. Nowadays, stress-related biomedical variables, such as (aberrant) physical activity, skin temperature, heart activity, and skin conductance, can be measured continuously and relatively easily using wearable sensors. Next to validation of algorithms (i.e. the relationship between wearable data and CB), it is of utmost importance to consider the different values, attitudes, and needs of all stakeholders involved to successfully develop, apply and implement this technology. Objective: To identify the values, needs, and attitudes of multiple stakeholders regarding wearables in the care of people with dementia and CB. Method: A qualitative study was conducted, in which a real-life context was created in a Dutch nursing home. Two residents with CB wore the Empatica E4 wristband for three half-days. Multiple stakeholders (i.e., eight involved nurses and eight informal caregivers) were interviewed. Subsequently, results were used for designing two focus groups. The first focus group included formal (n=6) and informal (n=6) caregivers. The second focus group consisted of community-dwelling people with dementia (n=7) and their informal caregivers (n=5) and case managers (n=2). Results: Stakeholders accepted the wearable as a supportive technology in the care of people with dementia and CB. Expected value, user comfort, need for information, and design (including customizability and stigmatization) were important themes. During the focus groups, explicit recommendations were given by the participants with respect to the wearables’ design. Conclusion: In order to enhance the adoption of wearable sensors in CB and dementia on an individual level, information about the technology and the design of the wearable deserves more explicit attention in clinical practice and future research.

Background: Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]). Method: This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data. Results: The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work. Conclusion: Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.

Children and adults with severe intellectual disability and complex needs often show behaviours and distress that carers and professionals find difficult to identify causes for, manage and decrease. The prevailing view is that these behaviours and distress are learned and consequently interventions focus on behavioural techniques. In this article we summarise the findings of research that indicate that behaviour and distress in this population are influenced by transient and stable characteristics or conditions that can interact with aspects of learning, be independent of learning, and interact with each other. These transient and stable characteristics or conditions are: pain and discomfort, sensory sensitivity, anxiety and low mood, sleep problems, atypical emotional regulation, specific cognitive difference, and differences in social behaviour. To aid carers and professionals, we present a checklist of the elements of an assessment process that covers these transient and stable characteristics or conditions and other relevant influences on behaviour and distress such as seizures, medication, learning and communication. We also draw attention to the benefit of identifying the cause of intellectual disability to inform the assessment process.

Purpose The purpose of this paper is to explore three main areas in relation to the interface between challenging behaviour and offending. Design/methodology/approach The first aim is to explore the labelling of behaviours as challenging or offending behaviour in the light of legal definitions, staff knowledge and beliefs and the mental capacity and mental health acts. The second is to explore challenging behaviour as a risk factor for offending in people with Intellectual Disability (ID).The third aim is to discuss the challenging behaviour as a barrier to discharge from secure services. Findings There is limited research suggesting that challenging behaviour such as physical aggression can lead to longer stay in forensic services, and this warrants further research. Originality/value This paper aims to promote discussion about the interface of offending and challenging behaviour in people with IDs and to promote best practice.

Purpose The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”. Design/methodology/approach The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed.

Purpose Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas.

Contains fulltext : 227106.pdf (Publisher’s version ) (Open Access) Background: Interactions with professional caregivers affect the quality of support and life of people with intellectual disabilities and contribute to the occurrence of challenging behaviour. The present literature review provides an overview of factors facilitating or hindering meaningful staff-client interactions in people with borderline to profound intellectual disabilities and challenging behaviour. Method: Database searches, reference list and citation screening, and expert consultations were undertaken. A thematic synthesis of 28 studies was performed. Results: Factors were identified at the client (i.e. behaviour, emotions and (dis)abilities), staff (i.e. interactive principles, knowledge, psychological resources, attributions, attitudes and (coping with) emotions) and context levels (i.e. group size, team and organization). Conclusions: The present overview provides insights into factors that facilitate or hinder meaningful staff-client interactions with people with intellectual disabilities and challenging behaviour. The results support the need to combine client, staff and contextual factors when considering staff-client interactions in research and practice. 13 p.

Purpose There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed.

Purpose The purpose of this paper is to provide an individual family-carer perspective on navigating the complex child, adult, education, health and social care systems focussing on what might be needed to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges. Design/methodology/approach This is a conceptual analysis, drawing on lived experience, policy and practice. Findings Policy and best practice advocate a holistic, person-centred, outcome-focussed approach to supporting individuals with learning disabilities whose behaviour challenges, but the existing complex multiple organisational structures are not conducive to delivering this. Making the system work for people requires focussed leadership across all levels to co-ordinate and align the component parts. It is certainly possible to achieve, but it is currently unclear who will take responsibility for making this happen. Originality/value Families are often the only constant in the lives of people with disabilities. This commentary highlights what is important to and for families when attempts are made to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges.

Purpose This paper aims to provide a commentary on papers in this special edition concerning the implementation of evidence-based practice from a clinician’s perspective. Design/methodology/approach The commentary makes a number of points drawing on both recent literature and the author’s own experience working as a clinician with children and adults with learning disabilities including those who are autistic whose behaviours can challenge themselves, their parents, carers and support networks. Findings Effective implementation requires clinical expertise to operate within a context of collaboration and partnership working, where co-production with those who have lived experience ensures that what clinicians offer resonates and contributes to improvements in quality of life for all. Originality/value The paper will be of value to clinicians working alongside children and adults with learning disabilities and their families, particularly clinical psychologists and behaviour specialists, and to other stakeholders wanting to enable and facilitate the development of high-quality support.

Purpose This study aims to evaluate the clinical effectiveness of the Mindfulness module of the “I Can Feel Good” programme, an adapted dialectical behaviour therapy (DBT) informed skills programme for a group of intellectually disabled offenders (IDOs). Design/methodology/approach The programme module was delivered to a group of five male IDOs detained under the Mental Health Act 1983 (Revised 2007) at an intellectual disability (ID) rehabilitation hospital based in the UK. The mindfulness module was 12 sessions in length, and it was evaluated using the emotional problems scale (EPS) and the cognitive and affective mindfulness scale-revised (CAMS-R) self-assessment and observational scale. These measures were administered pre- and post-module and used the staff report scales as a primary source of evaluation. Findings Non-parametric testing revealed that there was a reduction in scores post module on the externalising behaviour problem scale of the EPS and increased scores on the CAMS-R observational scale, which would indicate clinical improvement in the IDO’s behavioural presentation, although it was not statistically significant. The internalising behaviour problem scale showed increased signs of anxiety post module, this could be related to increased self-awareness. The CAMS-R self-reported measure indicated reduced mindfulness qualities following the module. Originality/value The results indicate that following the mindfulness module, there was a reduced level of challenging behaviour displayed by the patients with increased signs of emotional regulation. There was also an observed reduction in symptoms of depression and low self-esteem post module.

Many children with cerebral palsy face considerable challenges in their day to day life. Some will be highly dependent on those around them. While motor deficits are most commonly reported, children with cerebral palsy also experience higher rates of challenging behaviour, attention difficulties, social communication problems and to a lesser extent mood disorders in comparison to the general population. Personal risk factors for psychological distress include normal intellect, communication problems and less functional disability. Due to their need for higher levels of care and support, their parent's emotional state and parenting style also highly impacts on the child's development. Research groups have designed parenting interventions and mindfulness groups to support and enhance the parenting of young people with CP. This short article summarises what is known about the psychological experience of children and what interventions are helpful and evidence-based.

Teachers can at times view behavioural intervention procedures as time‐consuming. Thus, socially‐valid classroom‐based interventions are a critical component to behavioural success. This study examined the effects of traditional behavioural interventions with two kindergarten students presenting with challenging behaviours, including aggression, tantrums and noncompliance. Notably, it was found that traditional behavioural procedures were not sufficient to substantially reduce the behaviours alone. Therefore, a relationship‐building component was added to target positive student‐teacher relationships. Student outcomes resulted in a significant reduction in challenging behaviour as well as teacher‐reported behaviours showing a reduction across all measured periods. Ongoing teacher consultation, increased student‐teacher relationships (STRs) and use of effective classroom management strategies are necessary for effective models of behaviour support.

The aim of this study is to use Q methodology to explore how school staff experience the behaviours of children with Smith-Magenis Syndrome (SMS) in school and how they manage working with these children. Q methodology utilises by-person factor analysis to investigate subjectivity. Fourteen school staff of students with SMS in Norway participated and sorted 40 statements according to their own experience working with a student with SMS. Two distinct viewpoints were revealed, namely, 1) Managing challenging aggressive and self-injury behaviours in school where school staff experienced a range of challenging behaviours, especially aggressive behaviours. 2) Struggling with intense non-physical challenging behaviours in school where school staff experienced behaviours such as the students being very intense, craving attention and pushing buttons. In conclusion, there must be a greater emphasis on education and advising and supporting school staff’s work with the non-physical challenging behaviours aspects of teaching children with SMS, as well as a continued focus on challenging aggressive behaviours.