Predictors of challenging behaviour in adults with intellectual disability

2015 ◽  
Vol 9 (6) ◽  
pp. 312-326 ◽  
Author(s):  
Stella Koritsas ◽  
Teresa Iacono
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Living Arrangement ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Content Type ◽  
Future Assessment ◽  
Severity Of Disability ◽  
And Gender ◽  
Challenging Behaviours

Purpose – The purpose of this paper is to determine the extent to which mental health, physical health, communication, learned function of the behaviour(s), severity of disability, living arrangement, age, and gender, alone or in combination, predicted challenging behaviours in adults with intellectual disability. Design/methodology/approach – In total, 74 adults with intellectual disability and their paid carers were recruited into the study from adult disability services in Victoria, Australia. Paid carers provided information about participants with intellectual disability on a range of measures targeting each variable of interest. Findings – Based on principle components analyses of three challenging behaviour measures, two topographies of challenging behaviour emerged: contact and non-contact behaviours. Multiple regression analysis revealed that contact behaviours were predicted by anxiety scores and severity of disability. In addition to severity of disability and anxiety scores, non-contact behaviours were also predicted by sensory scores. Practical implications – The results of the current study indicate that contact and non-contact behaviours were determined by multiple factors. Clinicians and others who work with people who display challenging behaviour may, therefore, find it helpful to utilise the biopsychosocial model in their formulations of possible reasons that motivate a person to engage in challenging behaviour. Originality/value – These results contribute to the evidence base available to clinicians and researchers to guide future assessment for challenging behaviour. Expansion of functional assessment methods to explore factors not traditionally included, such as mental health and severity of intellectual disability, as causes of challenging behaviour, may prove helpful.

Antipsychotic prescribing for patients with intellectual disabilities and challenging behaviours

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Bushra Elhusein ◽  
Yassin Eltorki ◽  
Oraib Abdallah ◽  
Mohamed El Tahir
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Best Practices ◽  
Intellectual Disabilities ◽  
Challenging Behaviour ◽  
Prescribing Practices ◽  
Content Type ◽  
Antipsychotic Prescribing ◽  
Challenging Behaviours ◽  
Audit Standards

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.

A survey of consultant psychiatrists in intellectual disability based in England

2016 ◽  
Vol 10 (4) ◽  
pp. 258-270 ◽  
Author(s):  
Ashley Guinn ◽  
Sujeet Jaydeokar ◽  
Jane McCarthy ◽  
Ashok Roy ◽  
Angela Hassiotis
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Social Care ◽  
Community Mental Health Services ◽  
Evidence Base ◽  
Community Services ◽  
Content Type ◽  
Current State ◽  
Service Models ◽  
The Government

Purpose Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.

Families under pressure: stress and quality of life in parents of children with an intellectual disability

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Emma Staunton ◽  
Claire Kehoe ◽  
Louise Sharkey
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Intellectual Disability ◽  
Parental Stress ◽  
Rating Scales ◽  
Autism Spectrum ◽  
Challenging Behaviour ◽  
Parent Rating ◽  
Challenging Behaviours

Objective To evaluate stress and quality of life in parents of children with an intellectual disability (moderate–severe–profound), who attend a Child and Adolescent Mental Health Intellectual Disability Service (CAMHS ID), and to estimate the perceived levels of challenging behaviour and satisfaction with supports. Methods Data from children attending the service from 2014 to 2017, along with clinician and parent rating scales were collected. Results Most children had medical comorbidities, autism spectrum disorder (ASD), and challenging behaviours. Half had a diagnosis of a mental health disorder. Less than half received respite care. Challenging behaviours and ASD were found to be correlated with increased parental stress while perception of support was inversely correlated with stress. Intellectual disability, ASD, and parental stress were correlated with a decrease in perceived family quality of life. Conclusions This study concurs with previous studies, outlining that parents of children with intellectual disability, in particular, where there is a diagnosis of comorbid ASD and challenging behaviour, experience increased psychological distress and lower quality of life.

Psychodynamic psychotherapy in severe and profound intellectual disability

2020 ◽  
Vol 14 (3) ◽  
pp. 45-60
Author(s):  
Julian Himmerich
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Case Studies ◽  
Critical Review ◽  
Psychodynamic Psychotherapy ◽  
Quality Evaluation ◽  
Evidence Base ◽  
Inclusion Criteria ◽  
Content Type ◽  
Mental Health Difficulties

Purpose Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID. Design/methodology/approach A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review. Findings Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID. Research limitations/implications Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions. Originality/value This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.

Recovery colleges: long-term impact and mechanisms of change

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Holly Thompson ◽  
Laura Simonds ◽  
Sylvie Barr ◽  
Sara Meddings
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Positive Impact ◽  
Evidence Base ◽  
College Attendance ◽  
Personal Recovery ◽  
Structured Interviews ◽  
Content Type ◽  
Educational Paradigm ◽  
Long Term Impact

Purpose Recovery Colleges are an innovative approach which adopt an educational paradigm and use clinician and lived experience to support students with their personal recovery. They demonstrate recovery-orientated practice and their transformative role has been evidenced within mental health services. The purpose of this study is to explore how past students understand the influence of the Recovery College on their on-going recovery journey. Design/methodology/approach An exploratory, qualitative design was used and semi-structured interviews took place with 15 participants. Data was analysed using the “framework method” and inductive processes. Findings All participants discussed gains made following Recovery College attendance that were sustained at one year follow-up. Three themes emerged from the data: Ethos of recovery and equality; Springboard to opportunities; and Intrapersonal changes. Originality/value This research explores students’ experiences a year after attendance. This contrasts to most research which is completed immediately post course. This study contributes to the emergent evidence base highlighting the longitudinal positive impact of Recovery Colleges. This study is of value to those interested in recovery-oriented models within mental health. Recovery Colleges are gaining traction nationally and internationally and this research highlights processes underlying this intervention which is of importance to those developing new Recovery Colleges.

Rethinking mental health provision in the secure estate for children and young people: a framework for integrated care (SECURE STAIRS)

2018 ◽  
Vol 17 (4) ◽  
pp. 193-201 ◽  
Author(s):  
Jenny Taylor ◽  
Lisa Shostak ◽  
Andrew Rogers ◽  
Paul Mitchell
Keyword(s):  
Mental Health ◽  
Young People ◽  
Evidence Base ◽  
Content Type ◽  
Theoretical Concepts ◽  
Record Keeping ◽  
Care Plans ◽  
Trauma Informed Care ◽  
Assessment And Treatment ◽  
Trauma Informed

Purpose The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes. Design/methodology/approach The paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework. Findings The framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate. Practical implications These include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level. Originality/value This paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.

Attachment disorder in autism spectrum disorder and intellectual disability

2019 ◽  
Vol 13 (2) ◽  
pp. 57-66 ◽  
Author(s):  
Arvid Nikolai Kildahl ◽  
Maria Hagen Engebretsen ◽  
Sissel Berge Helverschou
Keyword(s):  
Autism Spectrum Disorder ◽  
Intellectual Disability ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Exclusion Criterion ◽  
Challenging Behaviour ◽  
Attachment Disorders ◽  
Attachment Disorder ◽  
Case Study Methodology ◽  
Content Type

PurposeAutism spectrum disorder (ASD) is an exclusion criterion for one of the two attachment disorders in the DSM 5. However, previous findings indicate that ASD and attachment disorder are unrelated conditions and may co-occur. The purpose of this paper is to explore the diagnostic assessment of an adolescent male with ASD, intellectual disability (ID), severe challenging behaviour and a suspected attachment disorder.Design/methodology/approachCase study methodology was chosen because of its suitability in the exploration of complex clinical phenomena where prior knowledge is sparse.FindingsIt was possible to identify symptoms of attachment disorder in a case involving ASD, ID, anxiety and severe challenging behaviour. The Disturbances of Attachment Interview was particularly useful in this assessment, as was assessment of ASD symptoms and developmental history. Differentiating the two attachment disorders proved challenging.Research limitations/implicationsThere is a need for further research in ASD and attachment disorders not limited by current diagnostic categories.Practical implicationsCo-occurring symptoms of attachment disorder may be identified in individuals with ASD and ID, and exploration of these symptoms in assessments of children and adolescents with ASD/ID and challenging behaviour may be beneficial.Originality/valueThe study adds to previous findings on attachment disorder in ASD, demonstrating that identification of attachment disorder is possible even in the presence of a highly complex clinical picture involving severe challenging behaviour. It may also assist other clinicians in identifying and making more accurate assessment of attachment disorder in ASD and ID.

Inpatient treatment of borderline personality disorder in adults with intellectual disability: reflections on practice

2019 ◽  
Vol 13 (2) ◽  
pp. 67-75
Author(s):  
Trine Elisabeth Iversen ◽  
Kristin Horndalsveen ◽  
Espen Matre ◽  
Tine Finstad Henriksen ◽  
Sarah Fusche ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Inpatient Treatment ◽  
Borderline Personality ◽  
Behaviour Problems ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type

Purpose There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

Personal Faith and Professional Ethics: Best Practice with the Families of Sexual and Gender Minority Youths

Social Work ◽  
2019 ◽  
Vol 64 (4) ◽  
pp. 365-372
Author(s):  
Sloan Okrey Anderson ◽  
Jenifer K McGuire
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Evidence Base ◽  
Gender And Sexuality ◽  
Mental Health Practitioners ◽  
Gender Minority ◽  
Health Practitioners ◽  
Sexual And Gender Minority ◽  
Therapeutic Services ◽  
And Gender

Abstract Religious mental health practitioners who hold traditional views of gender and sexuality may face moral and ethical dilemmas when working with sexual and gender minority (SGM) clients. Typical responses to this dilemma include selective positioning, values-based referrals, and attempted objectivity. Grounded in social work ethics and values, this article examines the evidence base, viability, and repercussions of these approaches. This article demonstrates the importance of cultural competence and affirmative therapeutic practices for religious mental health practitioners, whether or not they expect to work with gender and sexual minority clients or their families. In addition, the author tackles the difficult issue of providing ethical, evidence-based therapeutic services for religiously conservative parents of SGM children and adolescents. SGM people exist in every community, in every faith, and in every kind of family. The ethical treatment of SGM clients is relevant to all mental health practitioners, regardless of personal values or the type of practice they maintain.

The role of specialist inpatient rehabilitation services for people with intellectual disability, autism and mental health, behavioural or forensic needs

2019 ◽  
Vol 13 (5) ◽  
pp. 204-215
Author(s):  
Mahesh Odiyoor ◽  
Samuel Joseph Tromans ◽  
Regi T. Alexander ◽  
Srinaveen Akbari ◽  
Gill Bell ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Outcome Measures ◽  
Community Support ◽  
Inpatient Rehabilitation ◽  
High Standard ◽  
Standard Of Care ◽  
Rehabilitation Services ◽  
Content Type ◽  
The Uk

Purpose The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with intellectual disability (ID), autism and mental health, behavioural or forensic needs in the UK. Design/methodology/approach The concept of rehabilitation is discussed, as well as the functions and goals of specialist inpatient rehabilitation services with regard to the aforementioned contexts. Current use of rehabilitation beds is considered, both on a regional and national scale, as well as various outcome measures, including effectiveness, patient safety and patient experience. Findings There is a clear need for specialist inpatient rehabilitation services, though historically there have been instances of inappropriate admissions, as well as lengthy inpatient stays that could have been significantly reduced with the right type of community support package. Such services should be subjected to rigorous measurement of outcome measures, to determine that patients within such services are receiving a consistently high standard of care. Additionally, amendments to current legal frameworks should be considered, with a view to accommodating for individuals with capacity who require continuous community-based supervision. Originality/value To the best of the author’s knowledge, this is the first article detailing a professional consensus position for specialist inpatient rehabilitation services for people with ID, autism and mental health, behavioural or forensic needs.

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