Challenging Behaviour and Offending

Journal of Intellectual Disability Research

662

© The Authors. Journal Compilation © Blackwell Publishing Ltd

Symposium: Epidemiology of problem behaviours

Risk markers for challenging behaviour in children with severeintellectual disabilityL. E. Davies ([email protected])*, C. Oliver & J. L. Petty*Birmingham University, Birmingham B TT, UKAim: We investigated putative risk markers for challenging behaviourin children with severe intellectual disability (SID) and/or autismthrough the development of a brief screening instrument. Methods:Teachers from SID schools completed screening questionnairesregarding children aged between and years (mean = .years). Items in the screening questionnaire assessed potential riskmarkers including: diagnosis, degree of intellectual disability, presenceof health problems and repetitive, obsessive, overactive and impulsivebehaviour. Results: Analyses showed that children demonstratingaggressive, destructive and/or self injurious behaviour showed signifi-cantly higher levels of impulsive, overactive, repetitive and obsessivebehaviours than other children. Those identified as being on the autis-tic spectrum were significantly more likely to demonstrate challengingbehaviour. Health problems were significantly associated with severityof self injurious behaviour and aggression (all significant at p < .).Conclusions: These findings support and extend those of Petty() who identified health problems, repetitive, impulsive, overactiveand obsessive behaviour as possible risk markers for challengingbehaviour. The capacity of the screen to predict increases in the sever-ity of challenging behaviour over time is currently under evaluation.

Prevalence, incidence and remission of self-injurious andaggressive behaviour: Observational studyS.-A. Cooper ([email protected])*, E. Smiley, L.Allan,A. Jackson, J. Finlayson, D. Mantry & J. Morrison*Division of Community Based Sciences, Faculty of Medicine, University ofGlasgow, Glasgow G OXH, UKAims: To investigate point prevalence, incidence, and remission ratesof self-injurious behaviour (SIB) and aggressive behaviour, and iden-tify independently related factors. Method: Prospective cohort studydesign; general community setting. Participants were all adults (years +) with intellectual disabilities in a defined geographical area.Individual assessments were conducted. Results: Participation ratewas , (.%), and after years. Point prevalence of DC-LDSIB was .%, two-year incidence .%, two-year remission rate.%. Independently related to SIB were: lower ability, not livingwith a family carer, ADHD, visual impairment, and not having Downsyndrome. Point prevalence of DC-LD aggressive behaviour was.%, two-year incidence .%, two-year full remission rate .%.Independently related to aggressive behaviours were lower ability,female gender, not living with a family carer, ADHD, urinary incon-tinence, and not having Down syndrome. Conclusions: SIB andaggressive behaviour are not as enduring and persistent as previouslythought. Our study is a step towards identifying risk-markers, anddeveloping aetiological hypotheses for subsequent testing. The extentto which they are relapsing-remitting (episodic) problems requiresfurther investigation, as does further hypothesis-based investigation offactors that might be predictive of incidence and remission.

The association between indicators of psychiatric disorder andchallenging behaviourD. Felce ([email protected])* & M. Kerr*Welsh Centre for Learning Disabilities, School of Medicine, CardiffUniversity, Cardiff, CF YS, UKAims: To explore the association between psychiatric caseness andchallenging behaviour in a general practice based population of adultswith intellectual disabilities. Method: Data were collected on the age,gender, place of residence, adaptive and challenging behaviour, socialimpairment and psychiatric status of adults from general prac-tices. Psychiatric caseness was based on threshold scores on the Psy-chopathology Inventory for Mentally Retarded Adults (PIMRA), aninstrument which screens for eight major psychiatric conditions basedon DSM III criteria. Associations between caseness, total PIMRAscores and scores on the Aberrant Behavior Checklist (ABC) wereanalysed for groups matched on the Adaptive Behaviour Scale (ABS).Results: participants (%) attained threshold psychiatric case-ness. There were statistically significant differences between those withand without caseness in: presence of the triad of social impairments,ABC scores and PIMRA scores but not gender, age or ABS scores.PIMRA and ABC scores were significantly inter-correlated. Conclu-sions: The study shows a relationship between psychiatric casenessand challenging behaviour independent of adaptive behaviour leveland other potential confounds.

Symposium: Biological, cognitive and motivational extensions tooperant models of challenging behaviour

The relationship between specific cognitive deficits and syndromerelated behaviours in Prader-Willi syndromeK.A.Woodcock ([email protected])*, C. Oliver & G.W. Humphreys*Birmingham University, Birmingham B TT, UKAim: To investigate the hypothesis that a deficit in attention switchingcan interact with environmental and physiological factors to promoterepetitive questions and temper outbursts in Prader-Willi syndrome(PWS). Methods: Four individuals with PWS participated in threesingle case experiments in which behaviour and heart rate wererecorded. : Cognitive challenges placed demands on attention switch-ing : Controlled games presented changes to routines or expectations: Similar changes were imposed in the natural environment duringchange but not baseline sessions. Results: : Increased repetitivequestions, temper outburst behaviours and heart rate variability differ-entiated switching from control cognitive challenges. : Change condi-tions were differentiated from no-change conditions by increases inrepetitive questions and temper outbursts. : Temper outbursts onlyoccurred in change sessions. More repetitive questions and temperoutbursts occurred in change sessions relative to baseline. Conclu-sions: Behaviours associated with physiological arousal that could betriggered reliably in individuals by specific cognitive demands couldalso be triggered via environmental manipulations that are reported asproblematic in PWS. Support is provided for a directional relationshipbetween a specific cognitive deficit and behaviour, via environmentaland physiological interaction.

Gene-environment interactions in self-injury and aggressionP.Tunnicliffe ([email protected])*, J. Moss, J. Petty, G. Griffith,C. Oliver, P. Howlin & R. Hastings*Birmingham University, Birmingham B TT, UKAim: We explored the interaction between syndrome related differ-ences in social motivation and operant social conditioning in Corneliade Lange (CdLS), Angelman (AS) and Cri du Chat (CdCS) syn-dromes using a series of single case experimental designs. Method: participants aged between and years took part in the study. Allparticipants had been diagnosed with either: Cornelia de Lange (),Cri du Chat () or Angleman syndrome (). Brief experimental func-tional analyses were conducted in which the effects of social and nega-tive reinforcement on self injurious and aggressive behaviour wereexamined. Results: There was substantial variability in the reinforcingfunctions of self injurious and aggressive behaviour both within andacross syndromes. A syndrome related profile was more evident in ASthan in other syndromes The application of an algorithm to the datawill facilitate a more systematic assessment of differentiation acrossand between syndromes. Conclusions: Interactions between geneticeffect on social motivation and operant conditioning may lead to dis-tinctive social operant reinforcement processes within and betweensyndromes. This has implications for intervention (early interventionin particular) and for explaining the elevated prevalence of challengingbehaviours in some genetic syndromes.

Beyond experimental functional analysis to examine gene-environment interactions in challenging behaviourJ. Petty ([email protected])*, P.Tunnicliffe, J. Moss, G. Griffith,C. Oliver, R. Hastings & P. Howlin*University of Birmingham, Birmingham B TT, UKAim: Although the prevalence of self-injury and aggression is compar-atively high in Angelman (AS), Cornelia de Lange (CdLS) and Cri duChat (CdCS) syndromes little is known about the aetiology of thesebehaviours. In this study we employed structured descriptive assess-ments (SDA’s) and we recorded behavioural indices of pain to examinesyndrome related triggers and causes of challenging behaviour whentraditional functional analyses had proved inconclusive. Method:Twelve individuals showing self-injury and/or aggression with AS,CdLS or CdC with inconclusive experimental functional analysisresults participated in the study. Structured descriptive assessments,based on interview results, were employed within single case experi-mental designs Results: Pain, interruption of routines or behaviour,diverted adult attention and other idiosyncratic variables were identi-fied as influencing the levels of challenging behaviour for the majorityof participants but discrepancies between interview reports and theresults of SDA’s were evident. Conclusions: The analyses highlightthe benefit of assessment subsequent to traditional functional analysesin order to ascertain function of challenging behaviour in individualswith genetic syndromes. The discrepancies between interview andSDA’s suggest some level of stimulus control over the behaviours.

Symposium: Contributing factors to aggressive behaviours inadults with ID

Aggressive behaviors are associated with psychiatric diagnosesand degree of ID:A large scale surveyJ.A.Tsiouris ([email protected])*, I. L. Cohen, M. Flory,G. Heaney,W.T. Brown & J. Pettinger*NYS Institute for Basic Research, Forest Hill Road, Staten Island,New York, , USAAim: To evaluate the contribution of the assigned psychiatric diag-noses and the degree of intellectual disability (ID) to the types ofaggressive behaviours exhibited by persons with ID. Method: Psychol-ogists completed forms for % of all people receiving OMRDD ser-vices in New York State. (N > ; mean age (SD) = () years).Multi-variate analysis was performed with the four identified factors ofaggressive behaviours (aggressive displays, verbal threats, self injuryand severe aggression), type of psychiatric diagnosis and degree of IDcontrolling for age and sex. Results: Severe aggression was associatedto a significant degree with a) impulse control, psychotic, bipolar andpersonality disorders in persons with mild to severe ID and b) depres-sive and personality disorder in persons with borderline ID. Self-injurywas associated to a significant degree with all psychiatric disorders,but only in people with profound and severe ID. Aggressive displaysand threats were associated to a significant degree with all the psychi-atric disorders except anxiety and obsessive compulsive disorder inpersons with higher degree of ID. Conclusions: Psychiatric diagnosis,degree of ID and aggressive behaviour appear to be associated. Pro-found degree of ID seems to predispose to self injury in all the mainpsychiatric disorders.

A survey of aggressive behaviors and associated factors using the modified overt aggression scaleI. L. Cohen ([email protected])*, J.A.Tsiouris, M. Flory, R. Freedland,W.T. Brown & J. Pettinger*NYS Institute for Basic Research, Staten Island, New York, , USAAim: To assess the psychometric characteristics of the Modified OvertAggression Scale (MOAS). Method: Supervising psychologists fromthe New York State Office of Mental Retardation and DevelopmentalDisabilities (OMRDD) completed forms from % of all peoplereceiving OMRDD services in New York (N > ,; mean age (SD) = () years). Principal Components Analyses (PCA) and internalconsistency of the factors were carried out to assess construct validityand reliability. Clinical validity was also assessed. Results: PCAs onAggressive Behaviors yielded four factors: ) Aggressive Displays; )Verbal Threats; ) Self-Injury; and ) Severe Aggression. For SettingEvents, three factors emerged: ) Environmental Triggers; ) SocialIncursions; and ) Physical Discomfort. For Behavior ControlMethods, three factors also emerged: ) Negative Reinforcement; )Positive Reinforcement; and ) Medication/Behavioral Restraint. Inter-nal consistency measures were good. Factors were significantly associ-ated with almost all medical, etiological, and psychiatric categoriesprovided. Conclusions: The MOAS is a reliable and valid tool forassessment of aggression and associated factors in people with intel-lectual disabilities.

Biomarkers of aggressive and self-abusive behaviorW.T. Brown ([email protected])*, I. L. Cohen,R. Freedland, M. Flory, J. Pettinger & J.A.Tsiouris*NYS Institute for Basic Research in Developmental Disabilities, Forest Hill Rd., Staten Island, NY

As part of a large survey of the incidence of aggressive and self-abusive behaviours among >, New York State residents withMRDD, we were interested in determining whether biomarkers couldbe identified that correlate with such behaviours. Serotonin andtestosterone have been implicated in past studies among general popu-lations and functional polymorphisms of MAO-A have been linked toantisocial behaviour and to autism severity, as well as to amygdala andcingulate gyrus size. Mice studies have shown that heterozygous defi-ciency for COMT is associated with increased aggressive behaviour.Among subjects with diagnosed genetic syndromes, including FragileX, Prader-Willi, and Williams, aggressive profiles were more common.The next phase of our project will be to analyse potential geneticfactors and other biomarkers among selected subsets of our subjectswith either aggressive or self-abusive behaviours to search for suchcorrelations that point to etiological contributions. Implications fortreatments will also be discussed.

Symposium:Treatment of extreme challenging behaviouraccording to the triple C model:Theory and praxis

Assessing Triple C treatment of adolescents with mild ID andextreme challenging behaviourH. van Wouwe ([email protected])**ASVZ, postbus , AC Sliedrecht,The NetherlandsAim: The Triple C-support pyramid is a clinical treatment model forpeople with ID and extreme challenging behaviour. The model focuseson the relation with the client as well as on his competencies. In thisstudy the emphasis is on adolescents with mild ID and extreme chal-lenging behaviour. Firstly this study aims to describe the Triple Cindex, an instrument to assess the degree in which clients in our clini-cal setting are treated with our treatment model. Secondly it aims todescribe the correlation between the degree of Triple C treatment(measured with the index) and several characteristics of clients such asadaptive behaviour and problem behaviour. Method: Using the TripleC index clients are classified as being treated more or less ade-quately with our model. At the same time those clients are assessed oncompetencies and problems. Subsequently correlations are measuredbetween treatment and client characteristics. Results: Correlations arefound between the outcomes of the Triple C index and client charac-teristics. Conclusions: Further research is necessary to ascertain thatthe Triple C-support pyramid is a useful treatment model for clientswith mild ID and extreme challenging behaviour.

The relation-competence-therapy to influence the clients,the coaches and their reciprocal relationM. Oosting ([email protected])**ASVZ, postbus , AC Sliedrecht,The NetherlandsAim: People with ID and extreme challenging behaviour often havedamaged relationships with their environment and themselves. Mostclients suffer from attachment problems. Our clinical treatment isbased on the Triple C support pyramid, a relational model. The rela-tion-competence-therapy focuses on this reciprocal relation betweenclient and coaches. The therapy is given by a psychomotor therapist(focusing clients) and a trainer (focusing coaches). This study aims todescribe the effect of this therapy on clients, coaches and their recip-rocal relation. In common outdoor-activities both the clients and theircoaches are aimed at their reciprocal relation, thereby the clients focuson stress management and cooperation skills and the coaches onvision and competences. Method: By interviews and scales, informa-tion is collected about attachment behaviour, adapting behaviour andchallenging behaviour of six clients and the coaching styles of their sixcoaches. The information is collected at the beginning of the therapy(), at the end of the therapy () and months after the ending of thetherapy (). Results: The therapy has a positive effect on the behav-iour of the clients as well as on the coaching style of their coaches.Conclusions: The dual focus in this therapy on both the clients andtheir coaches seems to work.

Social survival:The relation-competence-therapy in an outdoor-activity settingP.Timmers ([email protected])* & A. den Hertog*ASVZ, postbus , AC Sliedrecht, the NetherlandsAim: In this therapy the treatment of clients with ID and challengingbehaviour and the training of their coaches is combined. Clients andcoaches cooperate in outdoor activities. By offering the possibility toacquire success experiences within challenging activities, the self-confidence of the clients and their confidence in the people aroundthem should increase. At the same time the competencies of thecoaches in their cooperation with the clients will grow. Method:Outdoor activities (wall climbing, rafting, hiking) are used for thetherapy. Clients and coaches are invited and forced to cooperate inchallenging situations. During the therapy we are consciously focusingon the work-alliance and stress management skills of the clients and atthe same time on the work alliance and coaching skills of the coaches.Results: The attachment behaviour of clients is being reinforced andtheir problem behaviour reduces. The coaches are developing moreskills in cooperation with the clients and sensitivity to their needs.Conclusions: This therapy offers many possibilities to reduce intensi-fying stress and to create a learning environment that fits the emo-tional, cognitive and motor developments. These outdoor activitiescreate the possibility to work on achieving goals and moving ownlimits.

IASSID World Congress Challenging Behaviour and Offending663


Symposium: Interventions for challenging behaviour:Do they work?

Community interventions for challenging behaviour:An introductionA. Canagasabey ([email protected])*,A. Hassiotis, D. Robotham, D. Langridge, R. Blizard & M. King*Community Learning Disabilities Service, Billericay CM ND, UKAims: The presentation will introduce the community based treat-ments for challenging behaviour. It will present data based on a sys-tematic review of published literature and will provide the frameworkon which the REBILD trial was based on.

Randomised controlled trial of specialist behaviour team vstreatment as usual in learning disabilities (REBILD): Outcomesand costsA. Hassiotis ([email protected])*,A. Canagasabey,D. Robotham, D. Langridge, R. Blizard & M. King*Department of Mental Health Sciences, Royal Free & University CollegeMedical School, London WW EYAims: To evaluate the impact of a specialist behaviour therapy teamon challenging behaviour in one catchment area. Methods: Threeyear randomized controlled trial of the behaviour therapy team vstreatment as usual. Participant or carer interviews took place at base-line, weeks and months. We measured behaviour change (mainoutcome), mental status (PASADD checklist), carer burden, commu-nity participation and costs for the previous months. We adoptedintention to treat analysis with last observation brought forward formissing data. Results: participants were recruited with in thetreatment arm and in treatment as usual. individual in each trialarm died and refused month follow up. We have almost completed month analyses (clinical outcomes) which showed that none of thetreatments is superior to the other although participants in the behav-iour team arm showed greater behaviour change as shown by reduc-tion in the Aberrant Behaviour Checklist scores. We are in the processof analysing the clinical data at months including costs.

Stakeholder perceptions of randomisation in intellectualdisabilities: Experience of a pragmatic trialD. Robotham ([email protected])*,A. Hassiotis,A. Canagasabey, D. Langridge, M. King & R. Blizard*Department of Mental Health Sciences, London WW EYAims: This study examined participant opinions and beliefs of Ran-domized Controlled Trials (RCTs) in intellectual disabilities. RCTs inthis field require co-operation from various stakeholders, includingcarers and professionals from a variety of disciplines. Previousresearch indicates that local stakeholders may interpret RCTs in thispopulation as potentially harmful and abusive. This is often com-pounded by communication issues with service users, and third-partyrestrictions on participant access. This study builds upon a recentRCT in intellectual disabilities. Methods: RCT participants wereinterviewed post-participation; The interviews elicited opinions, beliefsand decision-making processes relating to stakeholder and participantexperiences. Results: semi-structured interviews were conductedwith carers, health/social-care professionals, and service-users possess-ing sufficient capacity. Template analyses on the qualitative datarevealed that opinions about RCTs were shaped by several issues; easeof service access, ethical concerns about randomization, perceptions oflimited financial resources in this field. RCTs are ubiquitous in clini-cal research, including psychiatry. However, they present difficultiesfor researchers and participants in intellectual disabilities. Conclu-sions: This investigation provides information about important issuesarising for people planning to conduct future research with this population.

Symposium: Self-injurious behaviour

Is SIB related to addiction behaviors?J. Barnhill ([email protected])**University of North Carolina School of Medicine, Chapel Hill, NC, USAAim: This presentation will address the similarities between severeSIB and the behavioural neurobiological features of addictions. Thispresentation will also explore review current and potential treatmentoptions for both conditions. Methods: Data comes from clinicalcases, a review of the literature on both severe compulsive SIB andaddictions. This review of the literature will address the diversity andheterogeneity of SIB, especially the similarities between addictions andthe developmental trajectory, topography, typology, severity, specificbehavioural phenotypes, presence of co-existing challenging behav-iours/primary mental illness. Results: There are striking behaviouraland possible neurobiological parallels between some forms of addic-tion and a subset of SIB. These individuals are prone to chronic,episodic mutilating SIB that occurs in the context of specific ecologi-cal events, significant distress but minimal pain response. Thesebehaviours may end spontaneously but are often severe enough towarrant aggressive intervention. Conclusions: Addressing some formsof severe SIB as analogues to some forms of addiction is helpful, pro-viding insight into possible mechanisms as well as alternative methodsof treatment.

What people with intellectual disabilities say about their own self-injuryP. Heslop ([email protected])* & F. Macaulay*Norah Fry Research Centre, Bristol, BS TX, UKAim: To describe the views of people with intellectual disabilities inthe UK about their own self-injurious behaviour. Method: A small-scale qualitative study exploring the experiences of people with a widerange of intellectual disabilities who self-injure, and those who supportthem. Results: There was a clear view about when and why the self-injury started for most of the people with intellectual disabilities. Allof these were linked to unhappy or stressful circumstances in theirlives at the time. Some were able to identify times or circumstanceswhen self-injury was worse. These were generally related to times ofanxiety, frustration, uncertainty, loneliness or agitation. Times or cir-cumstances when self-injury was least related to the person beinghappy and occupied, having company, and being in a peaceful, stress-free environment. Conclusions: Many of the people with intellectualdisabilities, including those not verbally fluent, communicated in aninsightful way about their own self-injury. Taking the views of thoseconcerned into consideration is essential in order to support them inperson-centred empowering way.

Using functional analyses to assess bio-behavioural factors in the management of self-injury:A clinical case exampleS.Toogood ([email protected])*, F. Midoucha, L. Kovacs,A. Paris, R. Pritchard, M. Hoerger & S. Boyd*Bangor University, Bangor, Gwynedd LL AS, UKAim: An adolescent boy was referred to a specialist residential schoolwith a diagnosis of autism, severe intellectual disabilities and chronicself-injurious behaviour (SIB). Pre-placement descriptive functionalassessment suggested maintaining variables were task avoidance andaccess to tangibles. Staff implemented environmental enrichment,intensive skills teaching, differential reinforcement and functionalcommunication training procedures. Initial reductions in self-injurydid not maintain. Method: We hypothesized that biologically deter-mined low mood interacted dynamically with environmental establish-ing operations for SIB. Staff collected data on mood and SIB. Staff ’smood ratings and SIB correlated. We used brief experimental func-tional analyses (BEFA) in an A-B1-A-B2-A-C-A design to assess phar-macological treatments in conjunction with ongoing behaviouralintervention. Results: We observed no change in BEFA of SIB duringtreatment with low dose Risperidone (B1) or high-dose Risperidone(B2). SIB did not occur in BEFA during treatment with Prozac (C)and improved in home, school and community settings. Post-intervention withdrawal was delayed. SIB worsened during with-drawal. Treatment was reinstated before the final BEFA was completed. Intervention effects have maintained over time. Conclu-sion: Experimental and descriptive functional assessment may beuseful in helping clinicians identify variables maintaining SIB anddevelop effective treatments for persons with intellectual disabilities.


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Symposium:Aggressive behaviour

Ethology and neuropharmacology of aggressive behaviors inindividuals with intellectual disabilitiesJ. Barnhill ([email protected])**University of North Carolina School of Medicine, Chapel Hill, NC, USAAim: This paper will propose a model for challenging behaviours thatlinks functional behavioural analysis, ethological observation, neuro-ethological findings for aggression and pharmacotherapy. Method:The author will outline a method of clinical assessment that reframesdata based on behavioural analysis of subtypes of aggressive behav-iours based on current literature and research findings in neuro-ethology. Results: Aggressive behaviour can be conceptualized inethological terms such as territorial disputes, social dominance, chal-lenges to attachment bonds, predation and maternal/defensive behav-iours. Explosive aggressive behaviour differs from each of these basedon level of arousal, latency to aggressive behaviours, goal directednessof the behaviour, and restraining social influences. Behavioural andpsychopharm-acological interventions differ with respect to these sub-types of aggressive behaviour. Conclusion: Although controversial,human ethology is a useful in understanding challenging behaviourssuch as aggression in nonverbal individuals with severe ID. Thisapproach can help fine tune treatment planning by providing insightsinto the relationship between behavioural state and neurological sub-strates of aggression as a social behaviour.

Psychometric characteristics of the Modified Overt AggressionScale (MOAS)I. L. Cohen ([email protected])*, J.A.Tsiouris, M. Flory,R. Freedland,W.T. Brown & J. Pettinger*NYS Institute for Basic Research, Staten Island, NY

Aim: To assess the psychometric characteristics of the Modified OvertAggression Scale (MOAS). The MOAS includes information on theform and severity of aggressive behaviours; communication skills; levelof functioning; setting events; behaviour control methods; preventionissues; sensory/motor skills; medical issues; and etiological and psychi-atric diagnoses. Method: Supervising psychologists from the NewYork State Office of Mental Retardation and Developmental Disabili-ties (OMRDD) completed forms on almost all people receivingOMRDD services in New York (N > ,; mean age (SD) = ()years). Principal Components Analyses (PCA) and internal consis-tency of the factors were carried out to assess construct validity andreliability. Clinical validity was also assessed. Results: PCAs onAggressive Behaviors yielded four factors: ) Aggressive Displays; )Verbal Threats; ) Self-Injury; and ) Severe Aggression. For SettingEvents, three factors emerged: ) Environmental Triggers; ) SocialIncursions; and ) Physical Discomfort. For Behavior ControlMethods, three factors also emerged: ) Negative Reinforcement; )Positive Reinforcement; and ) Medication/Behavioral Restraint. Inter-nal consistency measures were good. Factors were significantly associ-ated with almost all medical, etiological, and psychiatric categoriesprovided. Conclusions: The MOAS is a reliable and valid tool forassessment of aggression and associated factors in people with intel-lectual disabilities.

The psychological impact of violence on staffJ. Rose ([email protected])*, R. Howard & V. Levenson*University of Birmingham, Birmingham B TT, UKAim: Staff in ID services can experience high levels of violence,which may lead to burnout, in turn leading to poorer quality services.This paper explores the relationship between levels of violence, fear of violence, self-efficacy, staff support and burnout using a surveymethod. Method: The participants included staff from residential set-tings including direct care staff in a medium secure setting with a highincidence of violence, and a community settings with a low incidenceof violence. Results: Participants from the medium secure settingreported significantly lower fear of violence and higher self-efficacywhen compared to community participants. Increased burnout significantly correlated with increased perceived exposure to physicalviolence and reduced staff support. Self-efficacy demonstrated a sig-nificant moderator relationship with levels of violence and burnout.Conclusions: This suggests that services which are organized tomanage violence may be better placed to support staff experiencingviolence. Fear of violence may decrease with exposure to violence,perhaps due to increased self-efficacy. Training and support for staffmay increase self-efficacy, thus reducing burnout.

Symposium: Interventions for challenging behaviour

RCT trial of diet treatment for adults with untreated PKUA.Amos ([email protected])* & G. H. Murphy*Tizard centre, University of Kent, Canterbury, Kent UKAim: Phenylketonuria (PKU) is a congenital metabolic disorder that,unless treated with a special low-phenylalanine (low-phe) diet frominfancy, leads to severe intellectual disabilities. The aim of this studywas to test the efficacy of the low-phe diet for adults with untreatedPKU. Method: adults with untreated PKU were recruited into adouble-blind randomized controlled crossover trial. Measures includedweekly blood phenylalanine levels, daily behavioural records, and, atthe end of each phase, standardized measures of skills and behavioursand direct observations. Results: Blood phenylalanine levels were wellcontrolled by the low-phe diet but there were no associated significantchanges in challenging behaviours. However, people who had the low-phe diet first were significantly more likely to withdraw (chi-squared,p < .). Also carers made more positive comments at the end of thelow-phe diet phase than at the end of other phases (chi-squared, p <.). Conclusions: Carers’ responses suggest detectable improve-ments in the behaviour of adults with PKU when treated with low-phediet, but this is not supported by quantitative analysis.

A teacher centred approach to children & young people with ID& challenging behaviourV. Milligan ([email protected])*, R. McConkey & E. Slevin*University of Ulster, Northern IrelandAim: To identify and develop classroom strategies teachers use tomanage/reduce challenging behaviours. Method: Using an actionresearch methodology, data was collected from four teachers and children (aged to years) with moderate intellectual disability,who displayed various challenging behaviours. Baseline measures ofbehaviours of the children were recorded using a Q-sort method.Following this, strategies were devised by teachers and guided by aresearcher, to reduce the children’s behavioural problems. Strategieswere reviewed and evaluated weekly by both the teacher andresearcher. Classroom observations were undertaken over a monthperiod. The strategies were revised as required. The types of strategiesused included positive behaviour support and choice making. Baselinemeasures were repeated at further time points to evaluate thesuccess of the strategies. Results: Effective strategies for whole classand individual pupil management were identified. In some cases on-task behaviours increased. However with others, reductions in targetedbehaviours resulted in other behaviours increasing. Conclusion:Strategies were identified that can be used by teachers to manage andreduce the number, frequency and intensity of behaviour incidents.Potential outcomes to this are enhancement of the children’s learningand improvement to their quality of life.

Support for family carers of children and young people withintellectual disabilities and challenging behaviour. How helpful is itperceived to be?G.Woodhouse & P. McGill ([email protected])**Tizard centre, University of Kent, Canterbury, Kent UKAim: Family carers of children with challenging behaviour reportreceiving inadequate and unhelpful support to manage their child’sbehaviour. We sought to identify why such support was often per-ceived as unhelpful. Method: Thirteen mothers, caring for a childwith intellectual disability who also displayed challenging behaviour,were interviewed. Parental perceptions of professional support wereanalysed using Interpretative Phenomenological Analysis. Results: Anumber of themes related to generic support services, including poorinformation provision, problems obtaining effective services, partner-ship and communication, and insufficient provision of respite andspeech therapy. Further issues were more specific to challengingbehaviour support, including an insufficient amount of support, lackof expertise about intellectual disability and challenging behaviour,ineffective strategies, and exclusion of the child from services due totheir behaviour. Conclusions: There is limited and rationed supporton offer to these carers. There is a strong need to improve training inorder to increase professionalism and promote more creative workingwithin the limited resources available. The value of more preventativesupport should be recognized, with more widespread adoption ofeffective behaviour support practices. More coordinated, collaborativeand respectful joint working between professionals, as well as morefamily-centred support is recommended.



Symposium: Reducing and managing challenging behaviour

Can we reduce the prevalence of challenging behaviour in peoplewith intellectual disabilities?P. McGill ([email protected])**Tizard centre, University of Kent, Canterbury, Kent UKThis paper argues for a paradigm shift in our thinking about challeng-ing behaviour in people with intellectual disabilities. Traditionally, suchbehaviour is conceptualized as an individual problem requiring assess-ment and treatment. Prevalence is measured by the percentage ofindividuals displaying challenging behaviour. Epidemiological studiespoint primarily to ‘at risk’ characteristics of individuals. Interventionfocuses on changing the individual or changing the way in which theirbehaviour is managed. I argue that such an approach is insufficient.Effective approaches to individual intervention have not reduced theprevalence of challenging behaviour. We should see challenging behav-iour as a ‘public health’ (as well as individual) issue and, consequently,take a more systemic approach. Specifically I will argue that:• we should stop thinking of challenging behaviour as just a character-istic of ‘at risk’ individuals;• we should measure prevalence by the frequency/severity of incidentsas well as the percentage of individuals who display it;• we should study the surrounding system-level meta-contingencies as well as contingencies surrounding individual behaviour;• we should extend intervention from treating the individual to reducing the prevalence of challenging behaviour.

The social validity of positive behaviour supportB. McClean ([email protected])* & I. Grey*Lanesboro St., Roscommon, IrelandAim: One of the defining features of Positive Behaviour Support isthat positive outcomes are significant to, and therefore continue to bereinforced by, key social agents. This paper presents outcomes of multi-element behaviour support plans and evaluates the effect of Pos-itive Behaviour Support on social validity. Method: Behaviour supportplans were developed as part of five consecutive longitudinal trainingprogrammes in which each participant conduncts functional assess-ments of behaviour with individuals prioritized in terms of theirneed for behaviour support. Outcomes are tracked with direct obser-vation and with Outcome Rating Scale, which is completed eachmonth by five members of the focus person’s circle of support.Results: Data on the reliability and validity of this measure of socialvalidity are presented. Results are compared with monthly data onbehavioural frequency, episodic severity and management difficulty ofmulti-element behaviour support. Conclusion: Effective PositiveBehaviour Support is strongly associated improved ratings of progressby key social agents.

The effectiveness of physical and mechanical interventions inresponse to challenging behaviourN. Beail ([email protected])*, H. Elford & Z. Clarke*Barnsley Learning Disability Service, Barnsley S RS, UKAim: In intellectual disability service systems physical and mechanicalrestraint may be used or prescribed for the management of severechallenging behaviours. However, such interventions have associatedrisks and moral and ethical issues. Thus professionals need to beaware of the impact and effectiveness of such interventions. Method:A search was conducted of relevant databases using a variety of termsassociated with restraint and intellectual disabilities. Results: Thecurrent literature on the effectiveness of physical and mechanicalrestraint is not large. Intervention studies show serious short falls inclinical practice and meta-analyses found equivocal results. Conclu-sions: The effectiveness of restraint varies and it is important this isused as a last resort in the context of a behaviour management planinformed by functional analysis.

Symposium: Challenging behaviour and transitions

Transition to adult services for young people with challengingbehaviour and intellectual disabilitiesD.A. Barron,A. Hassiotis ([email protected])* & C. Parkes*Department of Mental Health Sciences, Royal Free & University CollegeMedical School, London, UKAim: This project was undertaken by Camden Community LearningDisabilities to examine local processes of transition to adult servicesand the associated service demands of transition cases as they enteradult services. Method: The study took place in the London Boroughof Camden during the calendar year . The sampling frameincluded all individuals between the age of and years, who hadIntellectual Disability and were identified as exhibiting challengingbehaviours. We used the Mini PASADD (Prosser et al, ),Strengths and difficulties questionnaire (Goodman et al), ClientService Receipt Inventory ( months) (Beecham, ), Socio demo-graphic questionnaire and a challenging behaviour questionnairedevised by local clinical psychology service. Results: youngpersons have been identified as about to enter the adult IntellectualDisabilities Service. Interviews have been carried out todate and weare in the process of completing the rest of the interviews. We willreport on clinical and service characteristics and local developments.

Men with severe intellectual disabilities and challenging behaviourin transition from a locked ward: Follow upJ. Hubert ([email protected])* & S. Hollins*St Georges Hospital Medical School, London SW RE, UKAims: This paper describes the second half of a study of men withsevere intellectual disabilities and challenging behaviour in transitionfrom a locked ward of a long-stay hospital. The aims were () to gainsignificant understanding of individual men with severe intellectualdisabilities, and their lives, before transition to NHS campus and com-munity homes; () to document their experiences of the transition,and the nature of their new lives. Method: Ethnographic methods,involving long periods of participant observation, to get to know themen and to absorb the ethos of the ward. Family members were inter-viewed, wherever possible. The men were followed up after transitionat intervals up to years later. Results: On the ward the men hadlived emotionally and physically deprived lives, adult protection issueswere seldom acknowledged and individual, gender and social identitieswere not recognized. Their experience of transition varied, in manycases being protracted and bewildering. Quality of life improved insome respects in their new homes, but they remained ‘institutional-ized’ to an extent, depending largely on the attitudes and perspectivesof those caring for them.

Evaluating a transition model for people with intellectualdisability and complex behaviour:What works and what doesn’tV. Riches ([email protected])*, M.Y.Wiese & N. Pye*Centre for Developmental Disability Studies, Ryde, New South Wales ,AustraliaAim: A pilot program was established by Disability Services, Queens-land, Australia, in partnership with community sector agencies, toprovide short term accommodation and assessment to people with anintellectual disability who have complex and harmful behaviours. TheCentre for Developmental Disability Studies, The University ofSydney was engaged to undertake a formal evaluation of the first years of operation. Method: Both processes and outcomes were inves-tigated at multiple levels over the year time period, including theindividual, operational, managerial, infrastructure, policy andsocial/environmental levels. Results: The paper will report individualclient outcomes, staffing, cross agency collaboration issues, and theimpact on families and other stakeholders. Few of the desired out-comes planned for this model were achieved. Conclusions: A numberof significant challenges were presented, suggesting that a short termtransitional model may not provide long term quality of life outcomesfor clients with complex needs.


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Symposium: People with intellectual disabilities in prisons

People with intellectual disabilities and the criminal justicesystemJ.Talbot ([email protected])**Prison Reform Trust, Northburgh St, London ECV JRAims: To present findings and recommendations from researchundertaken in the United Kingdom on the experiences of people withintellectual disabilities and learning difficulties who come into contactwith the criminal justice system. Method: Empirical research: datagathering using structured interview techniques and questionnairesReview of relevant policy. Results: questionnaires returned byprison staff interviews with prisoners identified by prison staff ashaving intellectual disabilities or learning difficulties. Conclusions:People with intellectual disabilities and learning difficulties are notroutinely identified prior to arriving into prison and once in prisonface a number of difficulties. They are more likely to be victimizedthan other prisoners and are unable to access prison information routinely. They are likely to receive inadequate levels of support ofvarying quality and, because of their impairments, will be excludedfrom certain activities and opportunities. Their exclusion from offend-ing behaviour programmes in particular makes it less likely that theiroffending behaviour will be addressed and more likely that they willreturn to prison again and again.

Passports to advantage: Health and capacity building of prisonersafter releaseS. Kinner, N. Lennox ([email protected])*, K. Jamrozik,M. Haswell-Elkins, G.Williams & R.Alati*Queensland Centre for Intellectual and Developmental Disability,The University of Queensland, Queensland, AustraliaAim: Prisoners as a group are characterized by chronic social disad-vantage, high rates of risk behaviours and poor physical and mentalhealth, and some have an intellectual disability. Prisoners enter andleave custody with these existing problems. The majority will re-offendand almost a third will return to prison within years of release. Inthe weeks following release, ex-prisoners face a massively increasedrisk of premature death. There are no post-release programs whichsupport better health for ex-prisoners. Method: This project willconduct a randomized controlled trial of a post-release interventionfor all adult prisoners in Queensland and will identify people withintellectual disability. Prior to release, all participants will undergo ahealth assessment and receive a ‘health passport’ to encourage them tofind appropriate health and psychosocial support. Participants will alsoreceive telephone support in the first weeks following release. Theimpact of the intervention will be assessed through telephone inter-views , and weeks post-release, and by accessing correctionaland health records for participants years post-release. Conclusion:We hope to demonstrate decreased recidivism rates as a consequenceof health interventions. The findings of the study will inform thedevelopment of post-release intervention for prisoners.

Symposium: People with intellectual disabilities in court

Dual diagnosis of intellectual disability and mental illness in a court sampleS. Hayes ([email protected])*, M. Levy, K.Vanny & D. Greenberg*Centre for Behavioural Sciences in Medicine, University of Sydney,NSW AustraliaAim: To conduct psychometric assessment of accused persons in fourNSW (Australia) Magistrates Courts and attached police cells in thegreater Sydney area, to ascertain the proportion with an intellectualdisability (ID) and co-existing psychiatric disorder, in order to obtaininformation for designing services and diversionary options. Method:Accused persons appearing before the Courts were assessed using theKaufman Brief Intelligence Test-II (K-BIT II), the Vineland AdaptiveBehavior Scales-II (VABS-II), Hayes Ability Screening Index (HASI),the Psychiatric Assessment Schedule for Adults with DevelopmentalDisabilities Checklist (PAS-ADD), and an interview covering back-ground information. Results: A total of accused persons werescreened for an intellectual disability using the Hayes Ability Screen-ing Index (HASI), accused persons completed the KBIT-II, didthe VABS-II and did the PAS-ADD. Thirty percent had an IQbelow , % had adaptive behaviour scores in the same range, and.% had a psychiatric disorder. Conclusions: Preliminary resultsindicate that people with ID were overrepresented in local courtappearances and that there were high levels of mental health prob-lems. The results of this research will have important implications forpractice and policies relating to the treatment of people with ID earlyin the criminal justice system.

Delinquency and intellectual disabilityA.Avner, C.Aminadav, I. Kandel & J. Merrick ([email protected])**Ministry for Social Affairs, Jerusalem, IsraelAims: We discuss the definition of intellectual disability, delinquencyand the current model of handling delinquent behaviour amongpersons with ID in Israel. Methods: We present data for the– periods. Results: Out of referrals from the courts tothe diagnostic committees were found to be with intellectual dis-ability. The type of offences were sexual (%), intra-familial sexualabuse (%), violence (%), domestic violence (%), property (%)and other (%). Most of the offenders (% males, % Jewish) hadmild ID (%), while the rest were moderate ID. % were singlestatus, while % were married and % divorced. % were below age years, % between – years, % – years and % over years of age. % lived by themselves, % by parents, % in commu-nity settings and % in a residential care centre. Conclusion: Thedata indicated that most criminal acts committed by people with IDwere less severe than felonies committed by the general population.Another conclusion was that a large majority (%) lived in the com-munity with their parents or in their own home, which exposed themto situations where they sometimes lack the means, tools, and abilityto deal with appropriately.



Symposium: Sexual and violent offenders

Outcome of cognitive behavioural treatment for men at risk ofsex offencesG. Murphy ([email protected])* & SOTSEC-ID members*Tizard centre, University of Kent, Canterbury, Kent CT LZ, UKAim: Group CBT is the treatment of choice for non-disabled sexoffenders but men with ID are often excluded from such programmesand only a few studies of treatment for men with ID exist. Method:We report on a multi-site project which provided group CBT (specifi-cally designed for men with learning disabilities) to over men whohad sexually abusive behaviour and mild ID. The treatment groups ranonce per week for hours, over a period of a year. There were base-line measures of diagnostic factors, IQ and verbal skills, plus repeatmeasures of sexual knowledge victim empathy, cognitive distortionsand ‘re-offending’. Results: The results showed that there were statis-tically significant improvements in sexual knowledge, victim empathyand cognitive distortions by the end of the group. While most men didnot show further sexually abusive behaviour (up to mth follow-up),men with autistic spectrum diagnoses did less well. Some longer termfollow-up data are being collected. Conclusions: The CBT methodused here (SOTSEC-ID) shows promise in reducing sexually abusivebehaviour by men with intellectual disabilities.

The perspective of mothers whose adolescent sons withintellectual disabilities sexually offendJ. Hubert ([email protected])*, M. Flynn, L. Nicholls & S. Hollins*St Georges Hospital Medical School, London SW REAims: The aims of the project were () to determine whether grouppsychotherapy produced effective outcomes for adolescent boys withlearning disabilities who had been abused as children and were nowexhibiting sexually abusive behaviour; () to explore the perspectivesof parents and other care-givers; () to document the nature andextent of service support to families. This paper focuses solely on themothers’ perspectives. Methods: A year project with six boys (under) receiving group psychotherapy, using both quantitative and quali-tative methods. Clinical measures were used to track changes through-out the course of psychotherapy. Semi-structured interviews (tapedand transcribed) were held (separately) with the boys, their parents,paid care-givers, and therapists. Results and conclusions: Themothers felt almost totally unsupported by services, both in thepresent distressing circumstances, and in the context of the abuse oftheir sons in the past. They tried hard to make sense of, and come toterms with, what was happening to their sons and to themselves, theystruggled to reconcile their own confused and often conflicting emo-tions, and to maintain their own sense of identity. They could see littlehope for the future.

Assessing risk for violence in the intellectually disabled client:Environmental and client variablesD. Boer ([email protected])**Dept of Psychology, University of Waikato, Hamilton, New ZealandAim: In this presentation, the idea of expanding structured clinicaljudgement from primarily offender variables to a broader frameworkin which environmental (including staff) variables are given equal con-sideration in a comprehensive risk appraisal conducted for risk man-agement purposes of intellectually disabled individuals is discussed. Itis posited that only by contextualizing the individual’s risk within envi-ronmental variables can an accurate portrayal of current dynamic risk(and hence the management of that risk) be construed. Further, thenotion of client manageability as a function of overall risk will be dis-cussed. Finally, initial data on the implementation of the Assessmentof Risk and Manageability for Individuals with Developmental, Intel-lectual, or Learning Limitations who Offend (ARMIDILLO) are pre-sented from two groups of intellectually disabled offenders (IDOs).Method: A retrospective analysis of all IDO’s under the care of twocommunity organizations in New Zealand were analysed to see if theARMIDILLO was able to differentiate individuals of different actuar-ial risk levels. Results: The ARMIDILLO appears to provide a reli-able differentiation of IDO’s according to risk level. Conclusions:The use of a structured clinical guideline instrument designed for pro-viding information to aid in the risk management of IDO’s and thoseID clients with violent challenging behaviour appears to be warrantedby initial data.

Roundtable: Challenging behaviour – A symptom not a diagnosis: How can it be predicted and prevented?S. Hollins ([email protected])**Division of Mental Health, St George’s, University of London, LondonSW RE, UKJ. Siska ([email protected])**Department of Special Education, Charles University in Prague,M. D. Rettigrove , Praha , , Czech RepublicA. Bush ([email protected])**St George’s Community Health Centre, Sheffield S ND, UKJ. Hubert ([email protected])**Division of Mental Health, St George’s, University of London, LondonSW RE, UKIn different cultures, violence and vulnerability are managed in verydifferent ways, the least adaptive of these including the use of cagedbeds in eastern Europe, and the use of neuroleptic medication inmore affluent countries. Other more humane approaches include cre-ating supportive environments, supporting family and informal carersand providing a range of psychological therapies. The aim of theroundtable will be to stimulate future interdisciplinary research toidentify best practice in supporting individuals. Research leaders fromdifferent disciplines and different countries will briefly review relevantresearch findings and their implications for the prediction and preven-tion of aggressive challenging behaviour. There will be time for discus-sion and debate.


668


Posters

Communication assessment protocol in intellectual disability andthe criminal justice systemD.White ([email protected])**Children’s Hospital at Westmead, Department of Ageing, Disability andHome Care, Epping, NSW, AustraliaAim: Over the last couple of years, speech pathologists have more fre-quently been requested to become part of multidisciplinary teamsinvolved in the assessment and management of individuals from thispopulation. However, there is limited research literature available onthe communication skills of individuals with milder levels of intellec-tual disability and offending behaviours. For most speech pathologistsworking in disability services, investigation of at-risk behaviours andcommunication in this population is beyond their scope of experienceand training. For this reason, an assessment protocol was developed toprovide practice guidelines for speech pathologists working in thisfield. Method: A clinical forum and a discussion paper formed thebasis of the protocol. An extensive literature review was then con-ducted based on the themes and recommendations. Draft versions ofthe protocol were reviewed by multidisciplinary clinicians workingwith individuals with ID and CJS involvement, senior speech patholo-gists within a disability service and external clinical and academicexperts. Results and conclusions: The paper will present a review ofliterature on the communication skills of this population, an outline ofthe protocol and clinical examples.

Providing functional behavioural supports: Meeting expectationsH. Bischoff ([email protected])* & T. Rambow*W. International Airport Rd. Anchorage, AK USAAim: This paper addresses the key features and development of acomprehensive behavioural support system within one provideragency. Method: Survey data, client input and critical incidents sug-gested that we were experiencing inconsistent and ineffective behav-ioural supports. Because we were not meeting expectations ourprovider agency focused considerable effort on a meaningful andeffective strategy to build our behaviour support capacity. We recog-nized that direct service staff could not ‘handle’ many situations. Ourinitiative started with a close look at our behavioural health needs,documenting our vision, mission, values, beliefs and expectations, anddesigning implementation strategies within our means. Results: Wehave evolved our training programs for all staff members to includebasic teaching skills, behavioural principles and implementation strate-gies. Specialty training has also evolved and includes skills to developand implement interaction guidelines, intervention strategies, positivebehaviour supports and emergency response procedures. Conclu-sions: Ongoing evidence-based behavioural supports are a must andare now in place. While we have a values-based culture, continuum ofbehavioural support services and multiple training opportunities, westill have a long way to go. Challenges and new initiatives are also discussed.

Preliminary examination of the function served by challengingbehaviours associated with Fragile X and Smith MagenissyndromeP. Langthorne & P. McGill ([email protected])**Tizard Centre, University of Kent, Kent CT LZAims: Certain topographies of challenging behaviour, such as self-injury, constitute part of the behavioural phenotype for fragile X syn-drome (FXS) and Smith-Magenis syndrome (SMS). Only a smallhandful of studies have gone beyond behavioural form to address thefunction served by challenging behaviours associated with such syn-dromes. Method: The current study adopted indirect functionalassessment methods, using the Questions About Behavioral Functionscale, to examine the function served by challenging behaviours dis-played by children with FXS and SMS in comparison to a hetero-geneous sample of children with intellectual and developmentaldisabilities. There were approximately participants in each group.Results: Between-group analysis revealed differences between eachgroup in the total scores for certain subscales. For example, in com-parison to other groups, children with FXS were significantly lesslikely to display challenging behaviours maintained by attention.Within-group analysis also supported these findings. Conclusions:Results are discussed in relation to the concept of gene-environmentinteraction (GxE) and the implications such relations may hold bothfor our understanding of the early development of challenging behav-iour and in directing efforts at prevention and early intervention.

Posters

Systemic consultations for challenging behaviour: Beyondmediator and ecological analayisL.Whatson ([email protected])*, J. Dikian,K. Brearley, L. Mora,A. Hansson & P. Rhodes*Department of Ageing, Disability & Home Care, Level , BeecroftRoad. Epping NSW AustraliaAim: People with intellectual disability who present with challengingbehaviours are often identified as the presenting problem. The aim ofthis project is to define a clinical process for enhancing behaviourassessment such that factors that constrain or enable positive changewithin the family or service system are identified. Hence, the system,rather the person with the disability, is the focus of change. Systemstheory underpins this process which is applied in a reflecting teamformat. Method: Staff supporting people with intellectual disabilityare invited to present their views on the presenting issues to a reflect-ing team (the Systemic Consultation Clinic). Reflecting team membersview these issues through a variety of therapeutic lenses by asking‘curious questions’ in order to explore emerging themes and develophypotheses. Hypothesizing more broadly can suggest novel areas ofinvestigation and action. This project integrates systemic ideas withmore traditional behaviour assessment methodologies, such as ecologi-cal and mediator analyses. Results: Initial feedback from clinic partici-pants suggests that the Systemic Consultation process adds value toexisting behaviour assessment methodologies. Conclusion: This initialfeedback is promising. It highlights the need to develop a more rigor-ous research methodology to evaluate and implement this process.

Identifying, assessing and managing risk leading to improvedquality of life:A case studyJ.Walker ([email protected])**Wakari Hospital, Private Bag , Dunedin, New ZealandAim: To identify, assess, and manage risk for Wiremu, a -year-oldmale Maori with mild intellectual disability and a history of multipleaggressive acts toward family, support workers, and others. The RiskManagement Plan was designed to maintain optimal function, espe-cially relating to strengthening cultural identity, and to provide guide-lines to manage situations of risk. Method: File reviews and clinicalinterviews with Wiremu and significant others were completed.Detailed personal history and an overview of risk behaviours wereobtained. A specific Risk Management Plan was implemented. Inci-dent reports were collated at the end of an month period. Wiremu’sperceived quality of life and life satisfaction prior to, and following,the implementation of the Risk Management Plan were measured.Results: Wiremu became a Care Recipient with a Supervised Order(i.e. ordered by the Court to accept a care and rehabilitation pro-gramme) after an assault in . Since the development and imple-mentation of the Risk Management Plan there have been no furtherassaults on anyone; perceived quality of life and measured life satisfac-tion have improved markedly. Conclusions: The implementation of aspecific Risk Management Plan led to clinically significant improve-ment in level of risk, perceived quality of life, and life satisfaction.

Understanding CB from a community visitors perspectiveM.Tucker ([email protected])**The University of Queensland, Mater Hospital, Raymond Terrace,South Brisbane, Qld, Australia,

A pilot project was undertaken with a Queensland Government organization called the Community Visitors Program. This programemployees people to visit adults who have impaired capacity, that issomeone who has a psychiatric disability, intellectual disability,acquired brain injury or dementia. The Community Visitor helpspeople understand their rights and protect their interests. Aim: Togain information regarding the prevalence of challenging behaviour inQueensland. Method: A structured questionnaire was developed and Visitors collected data about the nature of the people they visit andthe exhibition of their challenging behaviour. Information regardingthe topography, frequency and severity of challenging behaviours wasobtained (over a three-month period). Data were collected across foursites: acute short stay mental health facilities, long stay mental healthfacilities, disability sector houses such as hostels and supportedaccommodation facilities such as group homes. This research was thefirst time any structured information had been collected about thenature of challenging behaviour being exhibited by those withimpaired capacity in Queensland. Results: These give a description ofhow many people with impaired capacity are exhibiting challengingbehaviour in Queensland across the described sites. Conclusions:Implications for this data are discussed.



Posters

A practical multi-sector system for identifying, assessing andmanaging riskL. Medlicott ([email protected])**Intellectual Disability Service,Wakari Hospital, Otago District HealthBoard, Dunedin, New ZealandAim: To develop a practical system that could be used to ensure thatpeople with an intellectual disability who have been identified as pre-senting with behaviours that present significant risk to themselves orto other people have such risk identified, assessed and managed in aclear and consistent manner. Method: This system has been devel-oped and refined through clinical experience. It involved the develop-ment of comprehensive documentation; the establishment ofinter-sectorial systems with service providers, needs assessors and hos-pital services; and implementing assessment and review processes. Thedocumentation includes information regarding the person’s optimalstate and suggestions about how to help them maintain that state, aswell as early warning signs and response suggestions, and informationabout greater risk behaviours. Results: While we do not have statisti-cal data regarding this, it appears as though this system has ensuredthat the behaviours of concern of those people with an intellectual dis-ability have been managed by support workers at an earlier time, and,most importantly, have helped the persons concerned to maintaintheir optimal state for longer periods of time. They have subsequentlybeen able to have improved access to community resources over timeand a decrease in external controls. Conclusions: This system is auseful process for the person and their support network to understandthe person themselves, their behaviours of concern, and how toencourage optimal functioning and respond to risk behaviours in themost effective and efficient manner.

Defining sexualised challenging behaviourK. R. Lockhart ([email protected])*, S. Guerin, S. Shanahan & K. Coyle*St. John of God Northeast Services, St. Mary’s Drumcar, Dunleer, Co.Louth, IrelandAim: Despite the stigmatizing effect of problematic sexual behaviour,research has often used narrow prospective definitions of such behav-iour. Furthermore, definitions of sexual offending and abuse are oftencriticized in their applicability to intellectual disability, given their con-notations of criminal intent or insight. The current study proposes theterm sexualized challenging behaviour and defines it using empiricalmethods. Method: Using an empirical qualitative methodology theprimary author analysed a six-month sample of service-based docu-mentation identified as reporting sexual behaviour that was problem-atic. Semi-structured interviews were also conducted with a purposivesample of staff (n = ) regarding their views on sexualized challengingbehaviour. Results: Common themes emerged across documentationand staff interviews regarding the nature and characteristics of sexual-ized challenging behaviour. The resultant definition encompassed acontinuum of self and other directed behaviours related to touch,exposure, and communication. The findings further suggest that sexu-alized challenging behaviour has distinct characteristics that differenti-ate it from non-sexualized challenging behaviour. Conclusions:Sexualized challenging behaviour can be defined as a distinct class of behaviour and has characteristics that differentiate it from non-sexualized challenging behaviour.

Identification of ID in forensic psychiatric setting:Preliminary resultsM. Moscato, D. Morin ([email protected])* & A. Crocker*University of Quebec, Montreal, CanadaAim: One of the criteria for the diagnosis of ID is limitations in theadaptive abilities of the individual. To evaluate this, many instrumentshave been developed but they are based on community environmentsand are difficult to apply to institutional settings such as prisons/secureservices. The goal of this study is to: ) establish the prevalence of IDin a forensic psychiatric setting; ) illustrate the difficulties encoun-tered in measuring adaptive behaviour in a closed setting. Method: Todo so, the preliminary results of an ongoing prevalence study of ID ina forensic psychiatric setting and its affiliated outpatient clinics will bepresented. The IQ of men between and years old was mea-sured by the WAIS-III. Their adaptive abilities were measured by theABAS-II by self-report and carer report. Results: of the menevaluate (, %) have limitation in both cognitive and adaptive abi-lities. Conclusion: The present study represents the first data on theprevalence of intellectual disability in forensic psychiatric setting usingboth cognitive and adaptive limitations in the evaluation.

Posters

Support for quality of life and challenging behaviour in people with IDA.A. C. Jansen ([email protected])*,A.Van Arnhem,C. B. Lunenborg, H. Nakken & B. F. van der Meulen*Centre of Consultation and Expertise, Utrecht en Noord-Holland, ABUtrecht, NetherlandsAim: In the Netherlands regional new ‘Centres for Consultation andExpertise’ (CCE) provide a consultation program (assessment, adviceand probably case management) for people with ID and severe problembehaviour.They have a pool of well over independent experts in thefield of care. A study about the effects of consultation from three CCEson improving quality of life and decreasing challenging behaviour wascompleted.Two hypotheses were formulated: ) The program as offeredby the CCEs reduces challenging behaviour and improves quality oflife. ) The effects of this program still exist months after completionof CCE support. Method: Data were collected using a dossier analysis,a questionnaire for quality of life and for challenging behaviour.Parents/representatives and direct support personnel filled in the ques-tionnaires. Data collection took place at the request for CCE support(T), after completion of the CCE support (T) and months aftercompletion of CCE support (T). Results: ) The first hypothesiscould be partly confirmed. However, not all of the individual resultsshow a decrease in challenging behaviour and improvement of QOL )The effect of CCE support persisted months after completion of theconsultation. Conclusions: In view of these results we will discuss ourconsultation program and how Bartiméus perceives the collaborationwith the CCE, on individual consultation, providing experts and collab-oration on a project with the aim QOL.

Problem behaviour with people with ID:A multidisciplinaryapproachM.Van den Berg ([email protected])*, X. M. H. Moonen & E. Krommenhoek*De Swaai,Wissel , EW beezsterzwaag,The NetherlandsAim: Behaviour problems in individuals with intellectual disability arefrequent topics of discussion among professionals because these diffi-culties often represent serious obstacles to the provision of care forthis population. These problems may have significant negative influ-ence on the person’s psychosocial development and mental health,may sometimes lead to the onset of mental illness and also cause suf-fering for people in the person’s environment. In this poster the ‘Prac-tice Guidelines and Principles’, previously released by the NADD andrecently in an European edition by the EAMHID, are presented froma multidisciplinary approach. Method: The Assessment, Diagnosisand Treatment – part of the guidelines are presented and commen-tated from a psychiatric point of view as well as from a psychologi-cal/orthopaedagogic point of view, the Related Support Services anddaily care are commentated from the care taker’s point of view.Results: The bio-psycho-sociodevelopmental, multidisciplinaryapproach of the guidelines must help to avoid a narrow perspective inwhich certain behaviour problems are interpreted only as person-related characteristics. Conclusions: It may therefore broaden theintervention strategies by addressing targeted modifications of environ-mental factors. This strategy respects human rights and recent effortsto bring about inclusion and social participation.

Rapport-based intervention for people with severe intellectualdisability and autismB. McClean ([email protected])**Lanesboro St., Roscommon, IrelandAim: This study evaluates the effect of rapport based intervention forfour individuals with autism and severe intellectual disabilities whopresent with escape motivated aggressive behaviour. Rapport-basedintervention is operationally defined, and video based examples arepresented. Method: Each case study follows a cumulative interventiondesign, in which the interventions follow a common implementationsequence: low arousal environment; establishment of rapport, estab-lishment of predictable routine and differential reinforcement.Results: The results are presented in terms of five outcomes: rates ofaggressive behaviour, mental health status, rates of medication, qualityof life and costs. They indicate significant reductions in rates ofaggressive behaviour, and associated improvements in mental healthstatus and social validity. Conclusion: The effectiveness of PositiveBehaviour Support for people with exceptionally severe challengingbehaviour is confirmed. There is preliminary evidence for an effectivesequence of interventions in Positive Behaviour Support, building onthe initial establishment of rapport.


670


Posters

Factors influencing the behaviour of people with ID and auditory disabilitiesM. Buskermolen ([email protected])* & W. Meindert*Koninklijke Effatha Guyot Groep, Hoogheemraadweg , VMAmsterdamAim: In several studies with people with ID it has been shown thatthere is a strong relationship between disrupted communication andbehavioural problems (Molteno, ; Sigafoos, ). Communica-tion problems form a barrier and the need for help is often expressedin terms of behaviour. It is therefore important to have a better under-standing of causes of behavioural changes. We aimed . To gain insightin motives for aggressive behaviour in people with an auditory andmental retardation and . To develop an observation – and registrationsystem for monitoring behaviour. Method: Behaviour of personswith ID and AD has been digitally recorded on a daily basis over aperiod of year using nine universal behavioural characteristics. Thesecharacteristics are described in five different levels of excitement,ranging from a state of relaxation to loss of control. Several externalvariables like social influences and nutrition were also recorded.Results: In this contribution we present the results of our studyincluding the relationship between external factors and behaviouralproblems. Conclusions: . By using the developed observationmethod it is possible to make reliable records. . It is possible todetect which external factors influence the behaviour. . Influence canbe made clear by correlations but not by trends.

Challenging behaviour:A unified approach – Using best practicestandards to evaluate the effectiveness of services for people whopresent challenging behavioursA. Bush ([email protected])* & S. Baum*Sheffield Care Trust/British Psychological Society, Faculty of LearningDisabilitiesAims: The aims of this study were to develop a local database of thenumber of service users who challenge services and to establish howwell local services performed against the standards described in theguidance document ‘Challenging Behaviour: a unified approach – clinicaland service guidelines for supporting people with learning disabilities whoare at risk of receiving abusive or restrictive practices’ (RCP, BPS, RCSLT). This report includes a ‘Good Practice Standards’ tool thatenables services to audit their practices against national guidance.Method: An audit was conducted on a pilot sample of people knownto one Community Learning Disability Team, who were identified asshowing challenging behaviours. The pilot selected standards as ameans of auditing the pathways of care and service provision for individuals. Results: The survey showed that there is a higher numberof service users with challenging behaviour known to the Team thannational estimates would suggest. The team performed well against themajority of the standards that were assessed. Gaps in service provisionincluded ‘care coordination’ and ‘risk assessment’. There was a stronglink between the specialist input provided by the teams and perfor-mance against the standards. Conclusions: The Good Practice Stan-dards provides an effective way by which services that support peoplewith challenging behaviour can audit their provision and identifyimprovements to the way in which they work.



Documents

Challenging Behaviour and Offending