Special issue on challenging behaviour
| Date | 12 June 2019 |
| DOI | https://doi.org/10.1108/AMHID-07-2019-072 |
| Published date | 12 June 2019 |
| Pages | 89-90 |
| Author | Rory Sheehan,Andre Strydom,Angela Hassiotis |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Rory Sheehan, Andre Strydom and Angela Hassiotis
Special issue on challenging behaviour
Challenging behaviour continues to be a common and disabling condition in people with
intellectual disabilities. Whether low level and requiring minimal intervention or severe enough to
warrant specialist multi-disciplinary assessment and treatment, it presents a significant challenge
to community intellectual disability services, and the debate on how to best manage the
presentation is by no means concluded. It is within this context that we believe a special issue is
still topical and important and the enthusiastic response to our call for articles serves to confirm
the relevance to researchers and practitioners alike. The group of papers included in this issue
cover a number of clinical and applied methodologies as authors approach the topic from a
variety of perspectives.
There is currently no single therapeutic approach or service model that can help all individuals at
all times and evidence, particularly around effective services, is poor and/or limited. NICE (2015)
guidelines, published in 2015, alarmingly show that recommended treatments for adults with
intellectual disabilities do not extend beyond Positive Behaviour Support (PBS). Psychotropic
medication continues to be heavily relied upon, despite the additional scrutiny applied to such
prescribing and the STOMP agenda led by NHS England. Recommendations for services can
read as a wish list of suggestions that may or may not find their way to local implementation
(NICE, 2018).
PBS receives much attention in this special issue. Botterill et al. present the results of a qualitative
exploration of family carer experiences of PBS and report the importance of taking a flexible and
collaborative approach with families if the intervention is to be successful. Both Gerrard et al. (in a
quasi-experimental design) and Conway et al. (applying Quality Improvement methodology)
show how adopting PBS in routine clinical services might augment efforts to reduce
anti-psychotic over-medication.
Enhanced support has been proposed as a factor in the successful maintenance of adults with
intellectual disabilities and complex needs in the community (NHS England, Local Government
Association and Association of Directors of Social Services, 2015), although the availability is still very
much a “postcode lottery”.Twostudies(Whiteet al. and Ravoux et al.) describe the development of
new intensive support services in UK community psychiatry teams; initial evaluations suggest positive
outcomes but larger-scale and longer-term studies are still needed to convince commissioners and
determine optimum service configuration and cost-effectiveness.
Increasing evidence attests to the importance and influence of paid carers in psychotropic use
for challenging behaviour (e.g. deKuijper and Hoekstra, 2019) and the paper by Sawyer et al.
presents a current picture of what Canadian direct support staff know about medication, as well
as highlighting their desire for additional training.
On an individual level, challenging behaviour is highly co-morbid and the case reports by Korb
et al. demonstrate the intricacies of making the distinction between challenging behaviour and a
treatable mental illness such as attention deficit hyperactivity disorder. In-depth assessment and
a commitment to a bio-psycho-social formulation are imperative if treatments are to be effective.
Finally, interventions can only be as good as the fidelity with which they are implemented.
Paulauskaite et al. present a systematic review of the fidelity of psychosocial interventions for
challenging behaviour and conclude that improvements are necessary at each step of the
pathway, from reporting of intervention fidelity in publications to delivering the intervention in
real-world conditions.
Rory Sheehan is based at the
Division of Psychiatry,
University College London,
London, UK.
Andre Strydom is based at the
Institute of Psychiatry,
Psychology and Neuroscience,
King’s College London,
London, UK.
Angela Hassiotis is based at
the Division of Psychiatry,
University College London,
London, UK.
DOI 10.1108/AMHID-07-2019-072 VOL. 13 NO. 3/4 2019, pp.89-90, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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