scholarly journals Clinical and cost effectiveness of staff training in the delivery of positive behaviour support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

2020 ◽  
Author(s):  
André Strydom ◽  
Alessandro Bosco ◽  
Victoria Vickerstaff ◽  
Rachael Hunter ◽  
Angela Hassiotis
Keyword(s):  
Autism Spectrum Disorder ◽  
Randomised Trial ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Cluster Randomised Trial ◽  
Challenging Behaviour ◽  
Treatment As Usual ◽  
Life Years ◽  
Health And Social Care ◽  
Positive Behaviour Support

Abstract Background: Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n=11 clusters) or to treatment as usual (TAU; n=12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = -2.10, 95% CI: -11.3 7.13, p =0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.Trial registrationClinicalTrials.gov: NCT01680276

scholarly journals Clinical and cost effectiveness of staff training in the delivery of positive behaviour support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial

2020 ◽  
Author(s):  
André Strydom ◽  
Alessandro Bosco ◽  
Victoria Vickerstaff ◽  
Rachael Hunter ◽  
Angela Hassiotis
Keyword(s):  
Autism Spectrum Disorder ◽  
Randomised Trial ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Cluster Randomised Trial ◽  
Challenging Behaviour ◽  
Treatment As Usual ◽  
Life Years ◽  
Health And Social Care ◽  
Positive Behaviour Support

Abstract Background: Although Positive Behaviour Support (PBS) is a widely usedintervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals.Methods: The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n=11 clusters) or to treatment as usual (TAU; n=12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12 months.Results: There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12 months (adjusted mean difference = -2.10, 95% CI: -11.3 7.13, p =0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080.Conclusions: Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions.Trial registrationClinicalTrials.gov: NCT01680276

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.

Aripiprazole in the treatment of challenging behaviour in adults with autism spectrum disorder

2012 ◽  
Vol 223 (3) ◽  
pp. 357-360 ◽  
Author(s):  
Iain Jordan ◽  
Dene Robertson ◽  
Marco Catani ◽  
Michael Craig ◽  
Declan Murphy
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Challenging Behaviour ◽  
Adults With Autism

Implementation of the Early Start Denver Model in an Italian community

Autism ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Costanza Colombi ◽  
Antonio Narzisi ◽  
Liliana Ruta ◽  
Virginia Cigala ◽  
Antonella Gagliano ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Young Children ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Model Group ◽  
Treatment As Usual ◽  
Early Start ◽  
Early Start Denver Model ◽  
Young Children With Autism

Identifying effective, community-based specialized interventions for young children with autism spectrum disorder is an international clinical and research priority. We evaluated the effectiveness of the Early Start Denver Model intervention in a group of young children with autism spectrum disorder living in an Italian community compared to a group of Italian children who received treatment as usual. A total of 22 young children diagnosed with autism spectrum disorder received the Early Start Denver Model in a center-based context for 6 h per week over 6 months. The Early Start Denver Model group was compared to a group of 70 young children diagnosed with autism spectrum disorder who received treatment as usual for an average of 5.2 h over 6 months. Children in both groups improved in cognitive, adaptive, and social skills after 3 months and 6 months of treatment. Children in the Early Start Denver Model group made larger gains in cognitive and social skills after 3 and 6 months of treatment. The Early Start Denver Model group made larger gains in adaptive skills after 3 months of treatment. Our results are discussed in terms of implications for intervention research and clinical practice. Our study supports the positive impact of the Early Start Denver Model in a non-English-speaking community.

Sign in / Sign up

Export Citation Format

Share Document