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Objectives: Behaviours such as hitting-out and declining personal care are commonly exhibited by people living with dementia and are associated with care-giver stress and anxiety and care home placement breakdowns. Traditionally, pharmacological approaches have been used to manage behaviour; however, research indicates limited effectiveness. National guidelines recommend use of non-pharmacological interventions as first line treatment for distress, but further research is required to elucidate the components that lead to improved care for people living with dementia. This study aims to explore what works, examining case studies in which a non-pharmacological clinical intervention, the Newcastle Model, was used to understand and manage distressed behaviour in dementia care within care home settings. Method: A qualitative case study design was used. Three cases were selected from the Edinburgh Behaviour Support Service for their success in preventing care home placement breakdown during a distressed behaviour intervention in NHS Scotland. Family members and staff involved in the interventions within these cases were interviewed (N = 6). Thematic analysis was used to analyse data. Findings: All participants reported positive outcomes from the intervention. Three key themes were identified, each with subthemes. Participants described a supportive, non-judgmental environment which allowed them to integrate knowledge about dementia and tailor interventions to the specific needs of the individual living with dementia. There was also a sense of family and staff coming together to unite with shared goals. A preliminary model of all of themes and their interactions is presented. Conclusion: The study supports use of biopsychosocial, formulation-led approaches in the understanding and treatment of complex behavioural presentations in community care settings. It suggests that clinicians should endeavour to facilitate safe and open environments for care home staff and family members, in order to promote attribution change and person-centered care, and to help mediate differences and conflict between staff and family members. [ABSTRACT FROM AUTHOR]

Uncommon behaviours such as aggression, apathy or restlessness are described as challenging behaviours in dementia care. On the one hand, this concept describes a practical problem faced by care staff and, at the same time, defines normatively how care staff should deal with this problem. A frequent benchmark here is the dignity of the person in need of care, which caregivers should also respect in the case of challenging behaviour. However, little is known about the normative standards that are effective in practice in everyday care when dealing with challenging behaviour. Researching these can provide information on which standards are actually applied and encourage reflection on which standards should be applied. In view of the fact that challenging behaviour can also be associated with aggression and/or violence in particular, an ethically significant question arises as to what effects the practical handling of such behaviour has on the extent of the willingness to use violence. The aim of this article is therefore to present empirical findings from an ethnographic study that focuses on the interpretation and practical handling of aggressive behaviour of care recipients by the nursing staff. In essence, it will be shown that a professional approach to challenging behaviour helps to prevent people with dementia in need of care from committing violent acts. If this finding is analysed in terms of its ethical implications, the conclusion suggests itself that the exclusion of the possibility of using violence is to be welcomed, since the exercise of violence makes respect for the dignity of another person, if not impossible, at least more difficult. However, it is questionable whether, under such conditions, the renunciation of violence can still be attributed the freedom required to qualify it as ethically good behaviour. [ABSTRACT FROM AUTHOR]

Background: There has been significant focus in the past decade on reducing admissions to assessment and treatment units for people with intellectual disabilities experiencing mental health or behavioural concerns. This has included the development of intensive support functions of National Health Service Learning Disability services to bolster community support and treatment for people at risk of admission. However, in recent years, there has been increased consideration of service development to include rehabilitation functions which would aim to proactively provide medium‐term additional input to individuals with a complexity of need. This input would aim to improve future trajectories and support the individuals to remain living a good life in their own community. This review focuses on community and in‐patient approaches to meeting a complexity of need. Method: A scoping review was carried out according to established best practice guidelines. Papers returned from the search were screened by the following inclusion criteria (a) Models or Outcomes of Rehabilitation; (b) Intellectual Disability Population; (c) Sample being 18 or above and (d) longer than short‐term stay/treatment, defined as 6 months or longer; and (e) Mental health and/or behaviour complexities. The search was conducted in electronic databases CINAHL, PsycInfo, Medline, Embase and Social Policy & Practice. Here, 3790 articles were initially identified and 27 were ultimately included in the review. Findings: There are few studies evaluating rehabilitation for people with intellectual disabilities and mental health or behavioural concerns. There was some evidence that accessing assessment and treatment inpatient provision resulted in clinical improvements. Some studies demonstrated initial evidence that longer term rehabilitation was beneficial as a step‐down from inpatient care. Some key principles were identified in terms of rehabilitation approaches: the need for person‐centred creative approaches, suitable staff training, focus on building skills, and a focus on increasing quality of life. Conclusion: There are some indicators of what good rehabilitation services might comprise for people with an intellectual disability, who have rehabilitation needs. However, far more research and guidance are required in this area. In particular, it is unclear whether rehabilitation is best provided within an inpatient or community model, and further detail is required about optimal components of such rehabilitation. Accessible Summary: Some people with an intellectual disability will need extra help with their mental health. People with more complicated needs might need support for a longer period of time.Longer term services can be in hospitals or in the community. These are called rehabilitation services.There is some research to show that rehabilitation services should be person‐centred and help the person learn new skills. The staff should have the right training and should help the person improve their quality of life. Much more research needs to be done on rehabilitation services for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Objectives: Autistic children frequently exhibit irritability, which can manifest as aggression, self-injurious behaviour, and severe tantrums, leading to significant impairments. Two atypical antipsychotics have been licensed by the Food and Drug Administration for the treatment of irritability in autistic children, although a significant percentage of these children do not respond to this treatment. This study aimed to determine the frequency of drug refractory irritability (DRI) and identify the risk factors in a large clinical sample of autistic children. Methods: The medical records of 1279 children aged 2–18 years diagnosed with autism and undergoing clinical follow-up were retrospectively analysed. Socioeconomic and clinical characteristics, co-occurring psychiatric disorders and physical conditions were recorded. Results: 55% of the sample used antipsychotics to treat irritability, and 8.2% met the DRI criteria. Older age, severe support requirement for autism, language impairment, anxiety disorders, sleep difficulties, gastrointestinal system, and dental problems were found to significantly increase the risk of DRI. Conclusion: Our findings indicate that a significant proportion of the clinical sample of autistic children had DRI. The physical, psychiatric, and environmental risk factors identified in our study also highlight heterogeneity in the etiology of DRI. Further research on DRI is needed to develop treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

Policies exist to regulate the use of restraint and seclusion so that they are only implemented when necessary and following appropriate standards and procedures. These policies often focus on students with disability. This qualitative study explored school leaders' understanding, use and perspectives of the Restraint and Seclusion Policy mandated for Victorian government schools, in relation to primary school-aged children with disability. Reflexive thematic analysis was undertaken on interviews conducted with eight leaders from six Victorian government schools. Five themes were developed: (i) Perceptions about behaviours of concern; (ii) Complex policy complicates implementation; (iii) Many factors determine policy implementation; (iv) Reporting is required but stressful; and (v) Support is important and includes, but is not limited to, professional development. Results indicate the Policy was valued but complex. School ethos, educator ideologies and understanding of behaviour, and the physical environment impacted policy implementation. Leaders felt the most effective approach to reducing restraint and seclusion use was preventing challenging behaviour through proactive and holistic approaches. Reporting was necessary but the process often felt arduous and judgmental for educators. The Restraint and Seclusion Policy was valued but needs to be user friendly and supported with professional development about understanding the policy, behaviour and disability. [ABSTRACT FROM AUTHOR]

Background: The review aimed to investigate the effectiveness of parent–child relationship interventions for families of children with intellectual disability up to 12 years old. Methods: Quasi‐experimental or randomised controlled trials (RCTs) of interventions targeting the parent–child relationship where ≥50% of children had an intellectual disability were included. Meta‐analyses of parent–child relationship outcomes and child outcomes used standardised mean difference as the effect size. Results: Twenty‐seven papers were included (N = 1325). Parent–child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication. Conclusions: Findings suggest that interventions targeting parent–child relationship quality are associated with substantial improvements in parent–child relationship and may improve child outcomes related to socialisation and communication. [ABSTRACT FROM AUTHOR]

Early childhood teachers receive some training related to overall classroom management but report receiving little training and support when working with children who engage in challenging behaviour. To alleviate the barriers to supporting students who engage in challenging behaviour, it may be helpful to implement a technology tool that provides early childhood teachers with evidence-based prevention and intervention supports for their students. One such tool, the Family Behavior Support App (FBSApp), has been previously used with families of young children who engage in challenging behaviour. The FBSApp has been shown to be effective in increasing families' use of strategies, but the effects of the app in educational settings are currently unknown. The purposes of this single-case study are to see if there is a functional relation between the use of the FBSApp-created behaviour plan and teachers' use of function-based behaviour strategies, as well as teachers' perceptions of the FBSApp. [ABSTRACT FROM AUTHOR]

According to Young Minds, ‘everyone gets angry sometimes’. Their website offers a number of de-escalating strategies, including staying calm, managing responses, and setting limits to help young people who most deem resistive. Yet, Young Minds are not alone because such logical advice is ubiquitous in the literature about challenging behaviour despite the fact that in our experience when faced with high states of arousal, most young people tend to act first and deal with the consequences later. It is not that they are stupid or non-caring, but they are human, capable of great feats as well as stupidity. The same is true for any claims that solution focused (SF) conversations can put right the several decades of psychological theory suggesting resistance requires logic and better cognition. By giving the correct thinking skills, young people will walk away from risk, avoid physical confrontation, handle challenging situations like logical thinkers, and generally discount that the process of growing up is part of the challenge. It is with this in mind that over recent years in our current SF practice (with staff group supervision), we have examined the concept of ‘resistance’ and how it can be put to use as a process of collaboration. To do this, we have revisited SF theory that preoccupied many of its pioneers during the 1980s and 1990s and attempted to make it useful for the early 2020s for professionals having conversations with young people, who, in traditional models, are labelled challenging. We want to introduce key differences of solution focused practice and how our research started to formulate a 6D-SF model (details, dynamics, dimensions, dispositions, dislocations, descriptions) for contemplating how groups of professionals relate to each other and are triggered by challenging behaviour. We do not claim to have proof, logic, or exactness on our side, but we are happy to suggest how our resistance mirrors what many of the staff teams feel and describe when working through their work.

Since individuals with severe and profound Intellectual Disabilities (IDs) have no concept of time, it is difficult for them to autonomously maintain daily structures. Those affected are dependent throughout their lives on external care structures. Even though research suggests that individuals with IDs should live in smaller facilities, individuals with higher support needs are more likely to be placed in large institutions and clustered group homes. The aim of this study was to define design criteria and test their applicability to a residential building design whose architecture enables individuals with IDs to develop autonomy through spatially experienced temporality. Qualitative data was collected in a mixed method evidence-based design approach: systematic behavioural observations, structured interviews, focus groups, and the UV-index method. Four design criteria could be described that contribute to an autonomy-promoting temporality: (a) spatial sequencing and repetition, (b) privacy-related variation of spatial dimensions, (c) spatial orchestration of daylight, and (d) constant emotional proximity to the caregiver. The hypothesis of using architecture to promote temporality in clients with IDs and Challenging Behaviour (CB) has proven to be potentially effective in designing a therapeutic environment. Our findings provide valuable data on how long-stay facilities should be designed in the future.

Introduction: Challenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB. Methods: A total of 18 caregivers (M= 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4-11 years (M= 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale. Results: We observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood. Discussion: ProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period. [ABSTRACT FROM AUTHOR]

Background: People with intellectual/developmental disabilities (IDD) are known to have high rates of prescription drug use, particularly for psychotropic medications. This is of concern due to the many side effects associated with these medications and because of the risks of polypharmacy. In this paper we compare the most commonly dispensed drugs and all psychotropic medications for youth with IDD compared with youth without IDD. Methods: Using population‐level administrative health data over a 10‐year period, this study examined medications dispensed to youth with an IDD aged 15–24 years compared with youth without an IDD. The most common medications dispensed and the number of youth they were dispensed to were determined. As well a wide variety of psychotropic medications were examined. Results: There were a total of 20 591 youth with IDD and 1 293 791 youth without IDD identified. Youth with IDD had higher odds of being dispensed pain medications, amoxicillin, salbutamol, levothyroxine and all the psychotropic medications (antidepressants, antipsychotics, anxiolytics, anti‐adrenergic agents, mood stabilisers and stimulants). For youth with IDD, 6558 (31.85%) were dispensed two or more different psychotropic medications within a year, compared with 75 963 (5.87%) of youth without IDD. Discussion: Compared to youth without IDD, youth with IDD had significantly higher odds of being dispensed most of the prescription medications studied, including all of the psychotropic medications. They were also twice as likely to be dispensed two or more medications from different classes of psychotropic drugs within the same year. These findings have important implications for the health of people with IDD and for their health care providers. [ABSTRACT FROM AUTHOR]

Individuals who have a dual diagnosis of both a psychiatric disorder and an intellectual disability (ID) are more likely to exhibit challenging behaviour than the general population. Clinicians globally have been encouraged to use positive approaches such as Positive Behaviour Support (PBS) when managing challenging behaviour. To explore nurses' views, opinions and perceptions on the use of positive behaviour support, as an adjunctive therapy, in the management of challenging behaviour in adults with a dual diagnosis of a mental health disorder and an intellectual disability within a mental health setting. A descriptive qualitative study was undertaken to identify registered nurses' experiences of using PBS in managing challenging behaviour. Data were collected from ten participants via semi-structured interviews and analysed using thematic analysis. Two themes were constructed; 1) Being involved from the beginning and 2) Impact on adults with a dual diagnosis. Nurses' involvement from the onset was fundamental in maximising the potential of PBS. Benefits of PBS were identified. Having a meaningful relationship with clients and a good knowledge of their behaviours was integral to the success of PBS. Participants emphasised the importance of continuous education around PBS. Nurses should be included in the formulation of PBS plans. • Nurses identified the need for continuous education around PBS, highlighting the potential benefits of practical workshops, where nurses could be afforded an opportunity to enhance their PBS skills. • Nurses held the belief that their inclusion in PBS formulation from the outset was imperative to help aid the success of the intervention. • This paper focuses on the views of nurses on the use of PBS in the management of challenging behaviour, in adults with a dual diagnosis of a mental health disorder and an intellectual disability. There has been an international focus on reducing restrictive practices in the management of challenging behaviours. Consequently, there is an increased use of PBS. It is important nurses use PBS from the onset to ensure the consistent management of challenging behaviours. Having a good rapport and relationship with clients has a positive impact on PBS outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study explored experiences of the management of challenging behaviours after traumatic brain injury (TBI) in the acute hospital setting from the perspectives of family members. Materials and Methods: A qualitative, interpretive phenomenological approach was adopted involving semi-structured interviews with 10 family members. Interviews were transcribed and analysed using thematic analysis, with Ecological Systems Theory applied as a guiding framework to discuss findings and implications for practice. Results: Four primary themes were identified: 1) The hospital environment; 2) Hospital staffing; 3) Identifying and preventing triggers, and 4) Family support and information. Conclusions: This qualitative study highlights the need for further information, education, and support to families of patients with TBI in the acute setting. Further research investigating the implementation of best practice approaches for managing challenging behaviours practice in acute settings is needed to overcome the barriers of the hospital environment, inexperienced and inconsistent staffing, and difficulties identifying triggers within the acute hospital setting, experienced by families. Approaches for family involvement in behaviour management strategies, and facilitation of communication for people with TBI in the acute setting requires exploration. IMPLICATIONS FOR REHABILITATION: Families reported the hospital environment, inexperienced and inconsistent staffing, and difficulty identifying triggers were challenges in effectively managing challenging behaviours after traumatic brain injury (TBI) in the acute setting. Clinicians can support family involvement in preventative strategies with patients with TBI. Clinicians can enable quality of care by building rapport and providing compassionate care to patients with TBI. Families need more support and information during the acute stage of TBI in hospital settings. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONPositive behaviour support (PBS) is recommended as a service response to challenging behaviours. In Australia, however, there has been concern regarding PBS policy and implementation. In response, this article proposes a tiered PBS service model for disability and community settings, which is evidence-based and rights-driven.Relevant literature, policy guidelines, and clinical experience are used to inform a positive behaviour support service model for community implementation.The Positive Behaviour Support in Disability and Community Service (PBS-DCS) model articulates systems-wide practices that support effective PBS provision within a human rights approach. The model describes three tiers of behaviour support: Tier I (Foundational), Tier II (Targeted), and Tier III (Specialist), and considers who should deliver which intervention elements and when.The PBS-DCS model provides a framework to support quality PBS practice in community settings. It is proposed that a proof-of-concept model of community-based PBS should be investigated—and that this would help to ensure current practice aligns with the professional expectations of PBS and deliver high quality services to people living with disability.A tiered behaviour support model of behaviour support is suggested to promote human rights of people living with disability and decrease costs associated with managing challenging behaviours by investing in good foundational practices.The positive behaviour supports in disability and community services model is proposed to provide clarity and accountability within and across service teams.The model could be used as the basis for a proof-of-concept model for auditing and quality appraisal, which is critical in developing more effective and/or efficient practices.A tiered behaviour support model of behaviour support is suggested to promote human rights of people living with disability and decrease costs associated with managing challenging behaviours by investing in good foundational practices.The positive behaviour supports in disability and community services model is proposed to provide clarity and accountability within and across service teams.The model could be used as the basis for a proof-of-concept model for auditing and quality appraisal, which is critical in developing more effective and/or efficient practices. [ABSTRACT FROM AUTHOR]

Background: Valid and reliable instruments for measuring emotional development are critical for a proper diagnostic assignment in individuals with intellectual disabilities. This exploratory study examined the psychometric properties of the items on the Scale of Emotional Development—Short (SED‐S). Method: The sample included 612 adults with intellectual disabilities (Mage = 37.35, SDage = 13.27; 59.8% males). Item validity analysis comprising sensitivity and specificity rates and discriminatory power were determined. Results: The relative mean frequency of 'yes' answers to all 200 items was 29.5%. The mean sensitivity rate was 67.5% and the mean specificity rate was 79.3%. Most items (85.0%) showed good discriminatory power with the adjacent stage(s), especially between SED‐1, SED‐2, SED‐3 and SED‐4. Particularly in SED‐4 some items showed weaknesses in the differentiation between these stages. Discussion: This study adds to previous validation studies by showing that most SED‐S items have psychometrically sound properties. [ABSTRACT FROM AUTHOR]

Background: Building 'key skills' may help prevent the development of challenging behaviour in children with an intellectual disability. The aim of this paper was to extend the current limited evidence in this area. Method: We undertook two studies with children with an intellectual disability in school settings: (1) a cross‐sectional replication study exploring the relationship between 'key skills' and challenging behaviour. (2) a longitudinal study follow‐up exploring change in 'key skill' levels and challenging behaviour. Results: The replication study recruited 74 participants, those scoring lowest in 'key skill' had a 94% chance of having challenging behaviour; those with the highest scores had a 6% chance. The follow‐up study recruited 39 participants, we found a significant increase in children's 'key skill' level (p <.001) and a decrease in their challenging behaviour (p =.046). Conclusion: Building 'key skills' in children with an intellectual disability may help reduce or prevent challenging behaviour. [ABSTRACT FROM AUTHOR]

Background: Stepping Stones Triple P (SSTP) is a complex parent‐mediated intervention aimed to reduce behaviours that challenge in children with moderate to severe intellectual disabilities, aged 30–59 months. Methods: To formulate a comprehensive understanding of SSTP implementation in the UK, we conducted a process evaluation collecting stakeholder views and considering intervention fidelity, dose, reach, delivery adaptations, and acceptability. Results: Fidelity and quality of delivery ratings were high. Parents perceived SSTP as valuable, reporting increased parental confidence and understanding of the child's behaviours. However, only 30% of families received an adequate dose of the intervention. Parents who only received treatment as usual described feeling abandoned by current services. Service managers emphasised the importance of availability of resources and therapist training for successful intervention delivery. Conclusions: SSTP supports effective management of early‐onset behaviours that challenge. Further work is needed to ensure equitable access to the intervention across health and social care services. Trial Registration: NCT03086876 – https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis+Angela&draw=1&rank=1. [ABSTRACT FROM AUTHOR]

Background: SYNGAP1‐ related intellectual disability (SYNGAP1‐ID) is a rare genetic disorder presenting with intellectual disability (ID), epilepsy, maladaptive behaviours and communication challenges. To date, few studies have assessed the context in which these maladaptive behaviours occur. This study aims to investigate the prevalence of problem behaviours, characterise the behavioural phenotype and use well‐validated measures to explore variables that maintain the behaviours. Methods: Our sample includes 19 individuals diagnosed with SYNGAP1‐ID and their parents. Parents provided information on behaviours that their children engage in, as well as their general behavioural dispositions. Well‐validated measures (e.g., the Repetitive Behaviour Scale‐Revised, Sensory Profile‐2 and Vineland Adaptive Behaviour Scale) were used. A subset of individuals underwent further direct experimental assessment of their problem behaviour to identify the variables maintaining those problem behaviours. Parental reports were analysed using nonparametric statistical analysis; the direct assessments of individuals' problem behaviour were analysed using visual analysis and validated supplemental measures. Results: All 19 individuals engaged in some form of maladaptive problem behaviour. Ratings of ritualistic, sameness and restricted behaviours measured by the RBS‐R were commensurate with individuals diagnosed with idiopathic autism spectrum disorder (ASD) while self‐injurious behaviours were endorsed at a higher level in SYNGAP1‐ID when compared with idiopathic ASD. The problem behaviours in our cohort of patients with SYNGAP1‐ID were maintained by automatic reinforcement and social attention and are positively correlated with atypical sensory responses. Conclusions: Individuals with SYNGAP1‐ID engage in problem behaviours commensurate with other populations (e.g., those with ASD), they exhibit atypical response to sensory stimuli. Problem behaviours were frequently maintained by automatic reinforcement, which may result from a dysregulated sensory system. Children with SYNGAP1‐ID may benefit from strategies used in persons with ASD. [ABSTRACT FROM AUTHOR]

Since individuals with severe and profound Intellectual Disabilities (IDs) have no concept of time, it is difficult for them to autonomously maintain daily structures. Those affected are dependent throughout their lives on external care structures. Even though research suggests that individuals with IDs should live in smaller facilities, individuals with higher support needs are more likely to be placed in large institutions and clustered group homes. The aim of this study was to define design criteria and test their applicability to a residential building design whose architecture enables individuals with IDs to develop autonomy through spatially experienced temporality. Qualitative data was collected in a mixed method evidence-based design approach: systematic behavioural observations, structured interviews, focus groups, and the UV-index method. Four design criteria could be described that contribute to an autonomy-promoting temporality: (a) spatial sequencing and repetition, (b) privacy-related variation of spatial dimensions, (c) spatial orchestration of daylight, and (d) constant emotional proximity to the caregiver. The hypothesis of using architecture to promote temporality in clients with IDs and Challenging Behaviour (CB) has proven to be potentially effective in designing a therapeutic environment. Our findings provide valuable data on how long-stay facilities should be designed in the future. [ABSTRACT FROM AUTHOR]

Background: Although family-centred positive behavioural support (FCPBS) has been shown to be effective in addressing challenging behaviours in autistic children, little attention has been devoted to parental cognitions and affect, which may impact outcomes. We evaluated the feasibility of delivering positive family intervention (PFI), a tertiary individualised approach to FCPBS that combines positive behavioural support (PBS) with cognitive behavioural therapy in a secondary group-based format. Method: Five mothers of children with autism participated in eight group-based PFI sessions. A single-case AB design examined basic effects on each child's challenging and adaptive behaviours in one target family routine. A pre-test-- post-test group design examined within-group effects on children's behaviours and parents' cognitions and stress. Results: Single-case results indicated that three out of five children showed improvement from baseline to intervention in challenging and adaptive behaviours. Pre-test--post-test within-group results indicated a significant decrease in children's challenging behaviour, but no significant improvements in children's adaptive behaviour or parents' stress and cognitions. Parents found group PFI to be practical and acceptable. Conclusions: This pilot study provides moderate support for the feasibility of adapting PFI to a group-based format for parents of children with autism. [ABSTRACT FROM AUTHOR]

Longitudinal research is crucial to fully assess the putative impact of the COVID‐19 pandemic on children with an intellectual disability in special school settings—ideally drawing on data pre‐pandemic to be able to evaluate later impact. Data on challenging behaviour and adaptive skills were collected annually for 348 students in one special school across four time points pre‐pandemic and one time point post‐pandemic. Data were analysed using multilevel models with repeated observations over the five time points. There was a decrease in aggressive and destructive behaviours and a decrease in adaptive skills at the post‐pandemic time point, after accounting for other important covariates. There was no evidence of a change in stereotyped or self‐injurious challenging behaviours. Other research using longitudinal methods is rare, but the current findings are consistent with previous research reporting on the impact of COVID‐19 on children and young people, particularly from parent reports. Future considerations for schools include adopting appropriate strategies to support learners to reintegrate back into education. Further research is needed to look at the longer‐term impact of the pandemic on challenging behaviour in children with an intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Compared with the general population, adults with an intellectual developmental disorder (IDD) are more likely to develop mental health problems and to receive high levels of psychotropic medication, particularly antipsychotics. The emotional development (ED) approach may help to better understand the nature of challenging behaviour (CB) and tailor treatment and support accordingly. The aim of this retrospective study was to investigate the impact of the ED approach on the prescription of psychotropic medication during inpatient psychiatric treatment. Methods: The clinical data of 1758 patients were analysed within a retrospective study design over a period of 12 years. ED level was assessed (1) for the first time (INITIAL‐SEO), (2) during a previous hospital stay (PAST‐SEO) or (3) not at all (NO‐SEO). The effects of the ED assessment and the respective intervention during the current admission on the number of psychotropics and the number and dosage of antipsychotics were analysed for the total sample, including those with CB, autism spectrum disorders and psychosis. Group differences were analysed by a chi‐square test and a one‐factorial analysis of variance. For analysing the impact of the application of the ED approach on psychotropic medication, a covariance model was applied. Changes between the subsamples were analysed by t‐tests for dependent samples. Results: The ED approach had a significant impact on reducing the overall amount of psychotropic medication and the dosage of antipsychotics in all patients with IDD. These effects were mainly attributable to those showing CB. In patients with autism spectrum disorders, the developmental approach reduced the number of antipsychotics. No effects could be observed in patients with psychosis; in this subsample, both the number and dosage of antipsychotics increased. Conclusions: The application of the ED approach in the current hospital stay reduced the number of psychotropic drugs and the number and dosage of antipsychotics, especially in those patients with IDD and CB, but also in those with autism spectrum disorders. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities often show challenging behaviour, which can manifest itself in self-harm or aggression towards others. Real-time monitoring of stress in clients with challenging behaviour can help caregivers to promptly deploy interventions to prevent escalations, ultimately to improve the quality of life of client and caregiver. This study aimed to assess the impact of real-time stress monitoring with HUME, and the subsequent interventions deployed by the care team, on stress levels and quality of life. Real-time stress monitoring was used in 41 clients with intellectual disabilities in a long-term care setting over a period of six months. Stress levels were determined at the start and during the deployment of the stress monitoring system. The quality of life of the client and caregiver was measured with the Outcome Rating Scale at the start and at three months of use. The results showed that the HUME-based interventions resulted in a stress reduction. The perceived quality of life was higher after three months for both the clients and caregivers. Furthermore, interventions to provide proximity were found to be most effective in reducing stress and increasing the client's quality of life. The study demonstrates that real-time stress monitoring with the HUME and the following interventions were effective. There was less stress in clients with an intellectual disability and an increase in the perceived quality of life. Future larger and randomized controlled studies are needed to confirm these findings. Assistive technology such as real-time stress monitoring enables caregivers to timely intervene and contributes to the reduction of challenging behaviour. Real-time stress monitoring contributes to the quality of life of clients and caregivers in healthcare. There is a reduction in the levels of stress of people with an intellectual disability by using stress-monitoring technology. [ABSTRACT FROM AUTHOR]

Uncommon behaviours such as aggression, apathy or restlessness are described as challenging behaviours in dementia care. On the one hand, this concept describes a practical problem faced by care staff and, at the same time, defines normatively how care staff should deal with this problem. A frequent benchmark here is the dignity of the person in need of care, which caregivers should also respect in the case of challenging behaviour. However, little is known about the normative standards that are effective in practice in everyday care when dealing with challenging behaviour. Researching these can provide information on which standards are actually applied and encourage reflection on which standards should be applied. In view of the fact that challenging behaviour can also be associated with aggression and/or violence in particular, an ethically significant question arises as to what effects the practical handling of such behaviour has on the extent of the willingness to use violence. The aim of this article is therefore to present empirical findings from an ethnographic study that focuses on the interpretation and practical handling of aggressive behaviour of care recipients by the nursing staff. In essence, it will be shown that a professional approach to challenging behaviour helps to prevent people with dementia in need of care from committing violent acts. If this finding is analysed in terms of its ethical implications, the conclusion suggests itself that the exclusion of the possibility of using violence is to be welcomed, since the exercise of violence makes respect for the dignity of another person, if not impossible, at least more difficult. However, it is questionable whether, under such conditions, the renunciation of violence can still be attributed the freedom required to qualify it as ethically good behaviour.

Background Adults with intellectual disability experience increased rates of mental health disorders and adverse mental health outcomes. Aim Explore childhood risk factors associated with adverse mental health outcomes during adulthood as defined by high cost of care, use of psychotropic medication without a severe mental illness and psychiatric hospital admissions. Method Data on 137 adults with intellectual disability were collected through an intellectual disability community service in an inner London borough. Childhood modifiable and non-modifiable risk factors were extracted from records to map onto variables identified as potential risk factors. Logistic and linear regression models were employed to analyse their associations with adverse outcomes. Results We showed that the co-occurrence of intellectual disability with autism spectrum disorder and/or attention-deficit hyperactivity disorder (ADHD) were associated with psychotropic medication use and high-cost care packages. However, when challenging behaviour during childhood was added, ADHD and autism spectrum disorder were no longer significant and challenging behaviour better explained medication prescribing and higher cost care. In addition, the severity of intellectual disability was associated with higher cost care packages. Ethnicity (Black and mixed) also predicted higher cost of care. Conclusions Challenging behaviour during childhood emerged as a critical variable affecting outcomes in young adulthood and mediated the association between adult adverse mental health outcomes and co-occurring neurodevelopmental conditions, that is, ADHD and autism. These findings emphasise the need for effective early intervention strategies to address challenging behaviour during childhood. Such interventions for challenging behaviour will need to take into consideration autism and ADHD.

Abstract Background Introducing new working methods is common in healthcare organisations. However, implementation of a new method is often suboptimal. This reduces the effectiveness of the innovation and has several other negative effects, for example on staff turnover. The aim of the current study was to implement the ABC method in residential departments for brain injured patients and to assess the quality of the implementation process. The ABC method is a simplified form of behavioural modification based on the concept that behaviour operates on the environment and is maintained by its consequences. Methods Four residential departments for brain injured patients introduced the ABC method sequentially as healthcare innovation using a stepped-wedge design. A systematic process evaluation of the implementation was carried out using the framework of Saunders et al. Descriptive statistics were used to analyse the quantitative data; open questions were clustered. Results The training of the ABC method was well executed and the nursing staff was enthusiastic and sufficiently involved. Important aspects for successful implementation had been addressed (like a detailed implementation plan and implementation meetings). However, facilitators and barriers that were noted were not addressed in a timely manner. This negatively influenced the extent to which the ABC method could be properly learned, implemented, and applied in the short and long term. Conclusions The most challenging part of the introduction of this new trained and introduced method in health care was clearly the implementation. To have a successful implementation serious attention is needed to tailor-made evidence-based implementation strategies based on facilitators and barriers that are identified during the implementation process. Bottlenecks in working with the ABC method have to be addressed as soon as possible. This likely requires ‘champions’ who are trained for the job, next to an organisation’s management that facilitates the multidisciplinary teams and provides clarity about policy and agreements regarding the training and implementation of the new method. The current process evaluation and the recommendations may serve as an example for the implementation of new methods in other healthcare organisations.

Background: This study assessed the effectiveness of a cross‐departmental case review panel—the Multicap Complex Behaviour Forum (CBF)—in reducing challenging behaviour exhibited by people with intellectual disabilities. Methods: Thirty participants (15 CBF participants and 15 matched‐control participants) took part in the study. Behavioural data was collected for each CBF participant (and their matched control) for the three‐month period before entering the CBF, during their time in the CBF, and the 3 months after exiting the CBF. Results: There was a significant interaction of group and time observed, with the CBF participants showing more change in behavioural incidents across time. Associated with this change was a noticeable reduction in staff injury costs related to the challenging behaviour of the CBF participants. Conclusions: This study demonstrates that positive behavioural and organisational outcomes are enhanced by fostering collaboration across multiple organisational systems when it comes to supporting people who exhibit challenging behaviours. [ABSTRACT FROM AUTHOR]

This study investigated the extent to which behaviour support services are accessible under Australia's National Disability Insurance Scheme (NDIS). We conducted semi-structured interviews with families who support a member with an intellectual disability and challenging behaviour. We analysed this data with a supply and demand access framework initially designed for health care and described the lived experiences of participants and their families accessing behaviour supports. Results show that while the NDIS has improved participants' ability to pay for behaviour (and other) supports, this financial capacity represents only one of six other important aspects of access. Families compensate for the shortcomings of the marketised environment which has arisen under the NDIS. This raises questions about the responsibilities of support provision, which is obscured in the new NDIS system and places responsibility for successfully accessing behaviour supports onto the family of the person with an intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Challenging behaviours are often a significant difficulty faced following acquired brain injury (ABI), for which PBS+PLUS (a Positive Behaviour Support framework) is an effective intervention. Clinicians report experiencing a range of barriers to supporting behaviour change for individuals with ABI and require tailored resources to support the implementation of PBS+PLUS. This study aimed to describe the process of co-designing a PBS+PLUS intervention guidebook and podcast series together with individuals with ABI, close-others, and clinicians, and qualitatively examine co-design experiences. Methods: The Knowledge-To-Action Framework was followed to support the translation of PBS+PLUS into clinical practice. Participants with ABI (n = 4), close-others (n = 7), and clinicians (n = 3) participated in focus groups contributing to the development of a PBS+PLUS intervention guidebook and podcast series. Following completion of the groups, qualitative interviews were conducted to understand participants' perspectives of the co-design experience. Transcripts were analysed using reflexive thematic analysis. Results: Co-design processes are described, and participants provided practical suggestions for co-design and the dissemination of developed resources. Two core themes encapsulating four sub-themes were identified. Firstly, ' Esteeming Experiences ' described the person-driven approach of co-design whereby participants felt supported and connected with other contributors and facilitators through sharing their perspectives. Secondly, ' Empowerment ' reflected participants' increased confidence and skills in applying PBS+PLUS. Conclusions: Overall, participants endorsed the therapeutic benefits of co-design engagement and high utility of PBS+PLUS resources. This study adds to the growing literature supporting the use of co-design methodology within clinical implementation, and is inclusive of individuals with ABI, close-others, and clinicians. Behaviour change is common and distressing after acquired brain injury (ABI); however, clinicians report a lack of training to address this. An intervention guidebook and podcast series were co-designed as training resources in PBS+PLUS, a behaviour support intervention. Participants with ABI, family members, and clinicians reported on many benefits of being involved in this co-design process and on the high utility of co-designed PBS+PLUS resources. Findings highlight the importance of involving stakeholders when implementing research into clinical settings. This article belongs to the Collection Clinical Implementation to Optimise Outcomes. [ABSTRACT FROM AUTHOR]

Background: Introducing new working methods is common in healthcare organisations. However, implementation of a new method is often suboptimal. This reduces the effectiveness of the innovation and has several other negative effects, for example on staff turnover. The aim of the current study was to implement the ABC method in residential departments for brain injured patients and to assess the quality of the implementation process. The ABC method is a simplified form of behavioural modification based on the concept that behaviour operates on the environment and is maintained by its consequences. Methods: Four residential departments for brain injured patients introduced the ABC method sequentially as healthcare innovation using a stepped-wedge design. A systematic process evaluation of the implementation was carried out using the framework of Saunders et al. Descriptive statistics were used to analyse the quantitative data; open questions were clustered. Results: The training of the ABC method was well executed and the nursing staff was enthusiastic and sufficiently involved. Important aspects for successful implementation had been addressed (like a detailed implementation plan and implementation meetings). However, facilitators and barriers that were noted were not addressed in a timely manner. This negatively influenced the extent to which the ABC method could be properly learned, implemented, and applied in the short and long term. Conclusions: The most challenging part of the introduction of this new trained and introduced method in health care was clearly the implementation. To have a successful implementation serious attention is needed to tailor-made evidence-based implementation strategies based on facilitators and barriers that are identified during the implementation process. Bottlenecks in working with the ABC method have to be addressed as soon as possible. This likely requires 'champions' who are trained for the job, next to an organisation's management that facilitates the multidisciplinary teams and provides clarity about policy and agreements regarding the training and implementation of the new method. The current process evaluation and the recommendations may serve as an example for the implementation of new methods in other healthcare organisations. [ABSTRACT FROM AUTHOR]

Background: Studies have found that presence of challenging behaviours and mental health problems limits employment for people with intellectual disabilities. This study investigates the associations between age, gender, living condition, level of intellectual disability, diagnoses, behaviour, mental health, and employment in adults with intellectual disabilities in Norway. Method: A cross‐sectional community‐based survey including 214 adult participants (56% men) with intellectual disabilities. Results: In our sample, 25% had no organised day activity, 27% attended non‐work day care, 19% attended sheltered employment, or day care with production, without pay and 29% worked in paid sheltered employment. One participant attended mainstream employment. Moderate and severe/profound level of intellectual disability, possible organic condition and irritability significantly reduced the odds of employment (paid and unpaid). Conclusion: Findings suggest unequal access to the sheltered employment that was meant to be inclusive. More individualised evaluation of prerequisites is suggested to further facilitate employment for this group. [ABSTRACT FROM AUTHOR]

Autistic individuals with intellectual disability are at greater risk of experiencing anxiety than their non-autistic peers without intellectual disability. Anxiety in this group may present as behaviour that challenges, often leading families to reach out to healthcare or support services. However, many families experience difficulties accessing services and, due to the lack of research into evidence-based anxiety interventions for people with intellectual disability, may not receive individualised support once in a service. This study explored caregivers' experiences of accessing services for autistic individuals with intellectual disability, and their considerations when developing new interventions for this population. Interviews and focus groups were completed with 16 caregivers of autistic people with intellectual disability. Reflexive thematic analysis was used to develop five themes about service access experiences, and three themes about caregiver considerations for anxiety interventions. Caregivers reported that their experiences of accessing services did not meet their expectations, and considerations for future anxiety interventions were often reflective of this. Interventions being flexible to family circumstances to aid accessibility, the embedding of peer support in services, and skills that can be generalised across the lifespan could be applied when aiming to improve outcomes and develop interventions for this under-served population. Many autistic individuals with intellectual disability experience anxiety, and for those who use few or no words, anxiety may present as behaviour that challenges, such as self-injury and avoiding anxiety-provoking situations. Families report difficulty accessing support from services for autistic individuals experiencing anxiety. Moreover, once receiving support, effective interventions for autistic people with intellectual disability are limited. We completed individual and group discussions with 16 caregivers of autistic people with intellectual disability, to (a) explore their experiences of accessing services for anxiety and/or behaviour that challenges for their child; and (b) understand what matters to caregivers when developing interventions that have been designed for them and the autistic individual with intellectual disability that they support. Caregivers reported that services, in their experience, did not deliver the support that they expected, and that they often needed to 'fight' for support. Caregivers considered services and families working together, the inclusion of peer support, and families being offered interventions that are flexible to individual circumstances to be important. These considerations are valuable for clinicians and researchers developing interventions and aiming to improve outcomes for autistic people with intellectual disability and their families. [ABSTRACT FROM AUTHOR]

The presence of sex-based asymmetry in the behaviours of youths with Autism Spectrum Disorder (ASD) is currently under research scrutiny. ASD is characterised by challenging behaviour (CB) and is often accompanied by anxiety, both of which often exacerbate social interaction difficulties. The present study examined the presence of sex-based asymmetry in the prevalence of CB and anxiety and in the association between CB and anxiety in a sample including 32 male autistic youths (M age = 10.09, SD = 3.83, range = 6–18 yr) and 32 female autistic youths (M age = 10.31, SD = 2.57, range = 6–15 yr) matched for age, IQ, and ASD severity (p >.101). While the prevalence and severity of behavioural characteristics across males and females with ASD were similar (p =.767), representing symmetry, there was asymmetry in the ways that CBs and anxiety were associated with each other across the two sexes. Specifically, there were 3 instances of symmetry (r >.3, p <.05)), but there were also 10 occurrences of sex-based asymmetry (r <.3, p >.05) in the association between five aspects of CB and five anxiety disorders. These findings emphasise the underlying sex-based symmetry in the prevalence of ASD-related behaviours, also highlighting unique sex-based asymmetry in the association between CBs and anxiety in autistic youths. [ABSTRACT FROM AUTHOR]

Managing the behaviour of young people is one of the critical roles of child and youth care workers working in child and youth care centres. However, these child and youth care workers have been found to be facing numerous challenges in their line of work which make it difficult to effectively provide behavioural interventions to young people in their care. The aim of this study was to explore the experiences of child and youth care workers when dealing with challenging behaviours of young people in residential care in eThekwini, South Africa. This study followed an exploratory research design that employed a qualitative research methodology. Three child and youth care centres were selected through purposive sampling from a population of such centres located in the eThekwini region in South Africa. Semi-structured interviews were used to collect data and thematic analysis was used to analyse the data. Results of thematic analysis indicate that child and youth care workers do experience difficulties in managing children’s challenging behaviour, viz. (1) experiences of working with young people; (2) insufficient supervision and support; (3) conflicts of behavioural intervention strategies; and (4) limited resources to support behavioural change in young people. Understanding these experiences is crucial for developing empowerment programmes (including strategies for countering the challenges) for child and youth care workers, which will ensure that young people receive comprehensive, optimal care. Support could include empowering child and youth care workers with skills and knowledge as well as the essential resources to effectively provide behavioural intervention for the young people in their care. [ABSTRACT FROM AUTHOR]

IntroductionChallenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB.MethodsA total of 18 caregivers (M = 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4–11 years (M = 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale.ResultsWe observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood.DiscussionProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period. RegistrationThe study was registered at https://www.drks.de (ID = DRKS00029039) on May 31, 2022.

This phenomenological study explored interpersonal violence experienced by nurses caring for persons diagnosed with intellectual disability at a selected psychiatric hospital in South Africa. In-depth phenomenological interviews were conducted with 16 nurses (female = 10, males = 06 with 2 to 16 and above years' tenure in long-term units). Using thematic analysis, three overarching themes emerged: (i) violence directed towards self and others; (ii) violence coping strategies; and (iii) support and skills development needs. Participants reported, for example, aggression and head banging aimed at causing harm to oneself and others as challenging behaviours that could potentially harm nurses and other patients. The nurses used adjustment and acceptance as coping strategies, including reliance on team support and being cognisant of their duty to care. These findings indicate a need for in-service training programmes to upgrade their knowledge inthis specialised field and for induction of new appointees serving in long-term units treating individuals with intellectual disability. [ABSTRACT FROM AUTHOR]

Background: Although many parents with intellectual disability (ID) demonstrate good parenting practices, some parents experience difficulties in managing challenging behaviours. One potential solution to this issue involves using The Family Game, a program designed to teach parents with ID how to manage challenging behaviours in their child. Aims: The purpose of our study was to conduct an independent replication of an investigation that had been performed by the developer of the program. Materials & Methods: We used a multiple baseline design to examine the effects of The Family Game on the behaviour of two parents with ID who had a 3‐year‐old child. Results: Similarly to the original study, our results indicate that The Family Game improved the use of effective parenting strategies during role play, but that these gains failed to generalise to real‐life settings. Conclusion: The study further supports the necessity of adding novel strategies to the game to better promote generalisation. [ABSTRACT FROM AUTHOR]

Background: Arabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population. Methods: All published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised. Results: The 79 included studies (n = 1243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well‐designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour. Conclusion: The evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations. [ABSTRACT FROM AUTHOR]

This study aims to contribute to the knowledge about lacking or contradictory effects of benzodiazepine on hyperaroused or aggressive behaviour in persons with intellectual disability (ID). We conducted a retrospective and natural case study in a person with mild ID and multiple adverse childhood experiences (ACE), using routine diary data consisting of 275 days including 113 consecutive days under benzodiazepine medication. The medication effects were documented as "calm / relaxed", "fretful / distressed" and "sleep / doze". Transitions between these were modelled using Markov chains. Differences in transitions were analysed using Chi-Square test for homogeneity. The results show a significantly reduced stability of mood and increased distressed behaviour under benzodiazepine. This is in line with reports about the effects of psychotropic medication in patients with ID and challenging behaviour. Besides other influences on unexpected medication effects, a possible dissociative identity disorder is discussed as an additional explanation. [ABSTRACT FROM AUTHOR]

Background: Young children with an intellectual disability have a higher risk of developing challenging behaviour (CB). Early identification of risk factors for CB allows for earlier intervention. The aim of the current study was to assess the prevalence and correlates of CB in preschool‐aged children with an intellectual disability in Riyadh (Saudi Arabia). Methods: One hundred twenty parents of preschool‐aged (3–6 years old) children who had been diagnosed (DSM‐5 criteria) with an intellectual disability completed an online cross‐sectional survey that included demographic, CB and child adaptive skills measures. The relationship between CB and 15 potential correlates (e.g. gender and degree of disability) was examined using independent samples t‐tests and chi‐squared tests. Results: Most preschool‐aged (3–6 years old) children with an intellectual disability exhibited CB (78.8%, 95% CI [70.3, 85.8]), with a 63.2% prevalence rate for self‐injurious behaviours (95% C [53.8, 72.0]), a 57.6% rate for aggressive destructive behaviours (95% CI [48.2, 66.7]) and a 25% rate for stereotypy (95% CI [17.7, 34.0]). The likelihood of a child engaging in self‐injurious and stereotyped behaviours was higher in those with autism and intellectual disability. Children with Down syndrome displayed fewer stereotyped behaviours. Low adaptive skill levels were associated with increased overall CB, self‐injurious and stereotyped behaviours. Conclusions: The identified correlates of CB in this population and cultural context align with the international evidence base. Findings have implications for the importance of early systematic screening of CB in preschool‐aged children in Saudi Arabia and other similar contexts. Preventative measures are suggested for preschool‐aged children with an intellectual disability who are more likely to demonstrate CB, such as those with autism and poor adaptive behaviours. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality. Design/methodology/approach: This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health). Findings: A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool. Originality/value: To the best of the authors' knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths. [ABSTRACT FROM AUTHOR]

There are no consistent answers to why challenging behaviour is perceived to be a problem across time and place. This article explores challenging behaviour and how it is constructed as a problem by professionals in North West England. The research was designed as a qualitative single case study that analysed the perspectives of staff from two primary schools and a local authority. The works of Michel Foucault and his interlocutors form the basis of the theoretical framework. This article shows that there are competing perspectives amongst practitioners regarding the problem of challenging behaviour. Deconstructing representations of challenging behaviours offers practitioners and researchers insight into how differing constructions of the problem shape policy solutions and educational experiences in schools. [ABSTRACT FROM AUTHOR]

Clinical practice guideline (CPG) recommendations for the management of challenging behaviours after traumatic brain injury (TBI) in hospital and inpatient rehabilitation settings are sparse. This systematic review aims to identify and appraise CPGs, and report high-quality recommendations for challenging behaviours after TBI in hospital and rehabilitation settings. A three-step search strategy was conducted to identify CPGs that met inclusion criteria. Two reviewers independently scored the AGREE II domains. Guideline quality was assessed based on CPGs adequately addressing four out of the six AGREE II domains. Data extraction was performed with a compilation of high-quality CPG recommendations. Seven CPGs out of 408 identified records met the inclusion criteria. Two CPGs were deemed high-quality. High-quality CPG recommendations with the strongest supporting evidence include behaviour management plans; beta-blockers for the treatment of aggression; selective serotonin reuptake inhibitors for moderate agitation; adamantanes for impaired arousal/attention in agitation; specialised, multi-disciplinary TBI behaviour management services. This systematic review identified and appraised the quality of CPGs relating to the management of challenging behaviours after TBI in acute hospital and rehabilitation settings. Further research to rigorously evaluate TBI behaviour management programs, investigation of evidence-practice gaps, and implementation strategies for adopting CPG recommendations into practice is needed. Two clinical practice guidelines appraised as high-quality outline recommendations for the management of challenging behaviours after traumatic brain injury in hospital and inpatient rehabilitation settings. High-quality guideline recommendations with the strongest supporting evidence for non-pharmacological treatment include behaviour management plans considering precipitating factors, antecedents, and reinforcing events. High-quality guideline recommendations with the strongest supporting evidence for pharmacological management include beta blockers for aggression in traumatic brain injury. Few guidelines provide comprehensive detail on the implementation of recommendations into clinical care which may limit adoption [ABSTRACT FROM AUTHOR]

The aim of this qualitative study was to description and interpretation of experiences and perceptions of teachers working with students who have challenging behaviours in various types of school settings in Poland. Teachers' experiences and perceptions provided insights and understandings into action strategies, in the case of the teachers who were interviewed, their assessing student difficulties and the effectiveness of various behavioural interventions. The data obtained from teacher interviews revealed their classroom management practices as well as their perceptions on the efficacy of their respective schoolwide practices for supporting students with behaviour support needs. [ABSTRACT FROM AUTHOR]