Aggression in Intellectual Disability — A New Approach
| Date | 22 July 2009 |
| Pages | 28-36 |
| Published date | 22 July 2009 |
| DOI | https://doi.org/10.1108/13619322200900012 |
| Author | Katie Turner,David Clarke |
| Subject Matter | Health & social care |
Mental Health Review Journal Volume 14 Issue 2 June 2009 © Pavilion Journals (Brighton) Ltd
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RESEARCH
Katie Turner
PhD Student, School of Psychology, University of Nottingham, UK
David Clarke
Head of School, School of Psychology, University of Nottingham, UK
Aggression in Intellectual
Disability – A New Approach
Abstract
Aggressive behaviour is a problem for services providing care for people with intellectual disabilities,
affecting the quality of life of the individual and the quality of care provided. Current research trends,
which focus on risk factors and mental health problems, are discussed. Other factors that could contribute
to aggression in people with intellectual disability (PWID), such as lifestyle and environmental issues are
examined. A methodology that would allow for the integration of all these factors, Behavioural Sequence
Analysis, is a suitable investigative approach to this problem.
Key words
Intellectual disability, aggression, violence, behavioural sequence analysis
The problem of aggression in
intellectual disability
Aggressive behaviour is a major problem for
services that provide care for people with
intellectual disability (PWID) (Tyrer et al, 2006;
Tenneji & Koot, 2007). Aggressive behaviour can
include verbal aggression (Crocker et al, 2006),
assaults on staff (Reed et al, 2004), self-injury
(McClintock et al, 2003) and sexual aggression
(Crocker et al, 2006). It is demonstrated by
10–15% of people with ID who use social
care services (Emerson et al, 2001), which
translates to around 12,000 people using ID care
presenting aggressive behaviour at any given
time (Department of Health, 2007). Aggressive
behaviour is the most challenging form of
behaviour encountered in ID services (Allen,
2000) and has a number of serious consequences
and implications for service users and carers. In
terms of service provision, those who display
aggressive behaviour are often denied access to
wider services – especially those located in the
community – as they are seen as presenting a
threat (Crocker et al, 2006). Within services,
care provision for aggressive individuals can
be reduced to strategies that minimise the risk
of violence but without the inclusion of other
fulfilling activities (Macmillan et al, 2004).
Finally, those who display aggressive behaviour
may be kept in unsuitable placements or have
a delayed discharge into the community due to
a lack of suitable services, resulting in further
obstructions to resettlement (Reed et al, 2004).
For the person engaging in aggressive
behaviour, this can cause difficulties in forming
interpersonal relationships (Jahoda et al, 1998)
and failure in employment placement schemes
(Allen, 2000). PWID who are aggressive are more
likely to be physically abused by their care-
givers (Emerson et al, 2001) and endure the use
of intervention strategies such as restraint or
sedation, which are stressful and do not benefit
them (Wilcox et al, 2006; Allen, 2000). The
stress of working in an aggressive environment
can lead to staff injury and increased sick leave,
which can strain an already stretched workforce
(Winstanley, 2005). Those individuals with ID
who exhibit aggressive behaviour would benefit
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