Challenging behaviour and associated risk factors: an overview (part I)
| Published date | 13 July 2012 |
| DOI | https://doi.org/10.1108/20441281211236643 |
| Date | 13 July 2012 |
| Pages | 199-214 |
| Author | Stella Koritsas,Teresa Iacono |
| Subject Matter | Education,Health & social care |
Challenging behaviour and associated risk
factors: an overview (part I)
Stella Koritsas and Teresa Iacono
Abstract
Purpose – This article is the first in a two-part series exploring challenging behaviour, its prevalence,
risk factors and causes. The aim of this article is to provide an overview of prevalence studies and
explore the various risk factors that have been associated with challenging behaviour. The authors also
seek to explore methodological differences across studies that may contribute to the prevalence
variations reported in the literature.
Design/methodology/approach – The article summarises the findings from freque ntly cited
prevalence studies as well as more recent studies.
Findings – The prevalence of challenging behaviour reported in the literature has varied due to
methodological differences across studies. Despite this, the best estimate is believedto be from 15 to
17.5 per cent. A range of factors have been associated with challenging behaviour and include gender,
age, severity of disability and residential setting.
Originality/value – This article appears to represent the most current overview of research in this area.
Keywords Challenging behaviour, Adults, Intellectualdisability, Review, Individual behaviour,
Learning disabilities
Paper type General review
People with intellectual disability, especially severe intellectual disability, are likely to display
challenging behaviours. Challenging behaviours are defined as ‘‘culturally abnormal
behaviour(s) of such an intensity, frequency or duration that the physical safety of the person
or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously
limit use of, or result in the person being denied access to, ordinary community facilities’’
(Emerson, 1995, p. 3). Among other behaviours, challenging behaviour includes self-
injurious behaviour (SIB), aggression, property destruction, stereotyped behaviour, socially
inappropriate behaviour, withdrawal, and non-compliance (Emerson et al., 2002).
Challenging behaviour has received substantial research attention because it affects the
quality of life of people with intellectual disability (Schalock, 2004) and their access to the
community (Emerson et al., 1988), has an impact on those who care for them (Rose, 1999),
and is costly to manage (Knapp et al., 2005).
This article is the first in a two-part series exploring challenging behaviour, its prevalence
and risk factors and causes. The aim of this article is to provide an overview of frequently
cited prevalence studies and explore common risk factors that have been associated with
challenging behaviour. The second part will explore the various models or theories that have
been proposed to explain why some people with intellectual disability display challenging
behaviour.
The prevalence of challenging behaviour
People with intellectual disability, especially severe intellectual disability, are likely to display
challenging behaviours (Emerson et al., 2002) . Reports of the overall prevalence
DOI 10.1108/20441281211236643 VOL.6 NO. 4 2012, pp. 199-214, QEmerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
PAGE 199
Stella Koritsas is based
at The Centre for
Developmental Disability
Health Victoria, Monash
University, Melbourne,
Australia.
Teresa Iacono is based at
La Trobe Rural Health
School, Bendigo, Australia.
of challenging behaviour (i.e. not specific topographies) have varied substantially. Table I
displays frequently cited studies exploring the prevalence of challenging behaviour, as well
as more recent literature.
The estimate of challenging behaviour in people with intellectual disability considered the
most accurate is 15-17.5 per cent, from the British Prevalence study (Kiernan and Qureshi,
1993; Qureshi and Alborz, 1992). These researchers conducted a population study of the
prevalence and nature of challenging behaviour in people with intellectual disability in seven
District Health Authorities in the UK. Prevalence was based on current challenging
behaviour that presented, or had the potential to present, a serious management problem.
The British Prevalence study was repeated (Emerson et al., 2001) using two of the original
seven districts. Emerson et al. (2001) reported that 12.1 per cent of people with intellectual
disability displayed challenging behaviour that presented, or had the potential to present,
a serious management problem. This prevalence was within the range reported by Kiernan
and Qureshi (1993).
As is evident from TableI, other than these studies and a few others (Lowe et al., 2007), there
is little consistency in the prevalence rates reported for overall challenging behaviour.
Prevalence differences are likely to arise from methodological variations across studies,
particularly with regards to definitions of challenging behaviour, as well as the specific
topographies that have been included in studies. Moreover, sampling techniques have
varied, as have the characteristics of participants. The measures used to assess
challenging behaviour have likewise varied, and the time frame for which behaviour needs to
have occurred to be considered challenging.
With regards to definitions of challenging behaviour, Table I shows that only Qureshi and
Alborz (1992), Emerson et al. (2002), Holden and Gitlesen (2006), and Lowe et al. (2007)
used the same definition. These researchers defined challenging behaviour based on its
impact. In contrast, Smith et al. (1996) defined challenging behaviours as those behaviours
included in a checklist developed for a service register; in the study by Borthwick-Duffy
(1994), challenging behaviours were those considered to be serious.
Differences in topographies included as challenging behaviour have largely arisen because
of different measures used to assess challenging behaviour. In many cases, topographies
included in research have been those that were included in existing challenging behaviour
checklists. Consequently, topographies that have been explored were those included in the
‘‘Disability Assessment Schedule’’ (DAS) (Holmes et al., 1982) in the study by Deb et al.
(2001), the ‘‘Aberrant Behavior Checklist’’ (Aman and Singh, 1986) in the study by
Chung et al. (1996), the Inventory for Client and Agency Planning (Bruininks et al., 1986) in
the study by Bruininks et al. (1994), and the Behaviour Problems Inventory (Rojahn et al.,
2001) in the study by Poppes et al. (2010). Interview schedules developed for the purpose of
prevalence studies have also been utilised to collect data about challenging behaviour,
occasionally with unknown psychometric properties (Hill and Bruininks, 1984).
Examples of variations in frequency and severity threshold levels for deciding when
behaviour was considered challenging included being rated as severe and occurring more
than three times/week (Deb et al., 2001), and being rated as present, regardless of
frequency or severity (Smith et al., 1996). In terms of variation in the time frame adopted,
Smith et al. (1996), for example, focused on behaviour that had occurred in the last 14 days,
whereas Poppes et al. (2010) explored those that had occurred in the previous two months.
For other research, the time frame utilised is unclear (Hill and Bruininks, 1984). Thus,
prevalence estimates have been largely dependent on how broadly or narrowly the
behaviour has been defined.
In addition to these methodological variations, sampling approaches have also varied. For
example, researchers have drawn data from existing service registers (Smith et al., 1996) or
have identified all people who accessed services in particular districts (Holden and Gitlesen,
2006). According to Borthwick-Duffy and Eyman (1990), service registers are likely to be
biased towards people with relatively urgent service needs and, therefore, lead to biased
prevalence estimates. Moreover, service registers are intended primarily for reasons other
PAGE 200
j
ADVANCES IN MENTALHEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 6 NO. 4 2012
To continue reading
Request your trial