Challenging behaviour or untreated ADHD?
| DOI | https://doi.org/10.1108/AMHID-12-2018-0053 |
| Date | 12 June 2019 |
| Published date | 12 June 2019 |
| Pages | 152-157 |
| Author | Laura Korb,Bhathika Perera,Ken Courtenay |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Challenging behaviour or
untreated ADHD?
Laura Korb, Bhathika Perera and Ken Courtenay
Abstract
Purpose –The purpose of this paper is to illustrate the possible basis of challengingbehaviour (CB) can lie in
a treatable neurodevelopmental disorder.
Design/methodology/approach –Two case studies were used to illustrate the clinical characteristics of
attention deficit hyperactivity disorder (ADHD) presenting as CB in people with intellectual disability (ID).
Findings –The findings of this paper show that the appropriate use of drug therapy for ADHD effectively
reduced the behavioural challenges.
Research limitations/implications –Limited by two cases. Application of the findings of this paper is
limited given it is a case study. This paper highlights an important clinical implications which need to be
studied in a larger scale to make clinical recommendations.
Practical implications –Findings from the two case studies may be used when making decisions in clinical
practice.
Originality/value –The paper explores the possibility of ADHD presenting as CB in people with ID.
Keywords Challenging behaviour, Intellectual disability, Learning disability,
Attention deficit hyperactivity disorder (ADHD), Hyperkinetic syndrome
Paper type Viewpoint
Learning objective
To consider ADHD as a differential diagnosis in cases of challenging behaviour in people with
intellectual disability.
Introduction
Attention deficit hyperactivity disorder (ADHD) is classified as a mental disorder in DSM-V
(American Psychiatric Association,2013) and has gained recognition as a clinicaldiagnosis in the
general population. Less attentionhas been given to the condition amongst peoplewith intellectual
disability (ID). In this paper, ADHD as an aetiological factor in the presentation of challenging
behaviour (CB) in people with ID is explored.Case studies are used to illustrate how treatment of
ADHD can improve CB in two people with ID and long-standing behavioural difficulties.
Challenging behaviour
Emerson (1995) describes “challenging behavior (CB)”in individuals with ID as “undesirable
behaviour that is of an intensity, frequency, or duration that threatens the physical safety of the
person or others or restricts access to community or facilities”. Such behaviour has complex
biopsychosocial aetiology and occurs in approximately 18 per cent of people with ID (Bowring
et al., 2017). Due to the role of psychosocial factors in behaviour, managing CB should involve
behavioural support plans to address the function of the behaviour (NICE, 2015), but Sheehan
et al. (2015) showed that the use of antipsychotic medication, mood stabilisers and anxiolytics in
the absence of underlying mental illness was high in people with ID.
Psychotropic medication may be appropriate to use in certain clinical situations especially where
the risks to the person and others due to behaviour is high (RCPsych, 2016). Such situations
Received 30 December 2018
Revised 21 March 2019
29 May 2019
Accepted 30 May 2019
Laura Korb, Bhathika Perera
and Ken Courtenay are all
based at Barnet, Enfield and
Haringey Mental Health NHS
Trust, London, UK.
PAGE152
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
VOL. 13 NO. 3/4 2019, pp.152-157, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-12-2018-0053
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