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AbstractBackgroundArabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population.MethodsAll published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised.ResultsThe 79 included studies (n = 1243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well‐designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour.ConclusionThe evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations.

Background  Interactive training (IT) is one of the two staff training components of the active support (AS) model. The present study explores how effective IT is when offered to staff divorced in time from the AS workshops, the other training component. We explored the effects of IT on resident activity engagement, challenging behaviours and staff assistance.Materials and Methods  Twenty‐one adults with an intellectual disability living in residential settings participated. Observations and ratings of staff and resident behaviours were obtained before, immediately after the training sessions, and at 6 months follow‐up.Results  Group‐level analyses indicated a short‐lived improvement in quality of staff support but, in general, there was an overall lack of change in staff behaviours, resident engagement and – observed and rated – challenging behaviours. However, subgroup analyses indicated that there was a significant improvement in engagement immediately after IT for a distinct subgroup of participants; those who had significantly higher aggressive behaviour ratings at the beginning of the study.Conclusions  Findings support the combination of the training components of AS for improvements in the quality of life for people with intellectual disability. IT may also be worthy of future study as a potential stand‐alone intervention for people with the most difficult challenging behaviours.

Background  The working culture surrounding challenging behaviour may have a strong effect on staff behaviour. As a first step to influencing staff talk about challenging behaviour, the aim of the present study was to explore whether a 1‐day training workshop could have an effect on staff causal explanations.Methods  Fifty‐four front line staff, in six separate groups, completed an adapted version of the Self‐Injury Behavioural Understanding Questionnaire (SIBUQ; Oliver et al. 1996) both before and after a 1‐day training workshop. The workshops were based on principles of Applied Behaviour Analysis. The SIBUQ comprised questions about causes of challenging behaviours presented in 11 short scenarios. The four possible response options for each scenario reflected behaviourally correct, behaviourally incorrect, internal emotional, and internal organic causal explanations.Results  The number of correct behavioural causal hypotheses increased significantly from pre‐ to post‐training. The proportion of incorrect causal explanations that were behavioural in orientation also increased significantly from pre‐ to post‐training.Conclusions  Staff causal explanations for challenging behaviour can be changed using a relatively brief intervention. Further research is needed to establish whether such changes can be used to influence working culture in challenging behaviour services.

Background  Existing theoretical and empirical work in the intellectual disability field has paid little attention to parents' positive perceptions of their child and the positive impact that the child may have on the family generally. The main aim of the present study was to explore the factors related to the mothers' positive perceptions of their child with intellectual disability.Methods  The mothers of 41 children with intellectual disabilities completed a self‐report questionnaire that measured demographic factors, child demographic variables (including caregiving demand), social support, coping strategies and dimensions of positive perceptions.Results  Mothers' perceptions of the child as a source of happiness/fulfilment and as a source of strength and family closeness were positively associated with reframing coping strategies. Mothers' perceptions of the child as a source of personal growth and maturity were also positively associated with reframing coping strategies, the helpfulness and usefulness of support from family and friends, and the caregiving demand.Conclusions  The relationship between coping and parental positive perceptions requires more investigation both theoretically and empirically. This relationship may also have important implications for the support of families of children with intellectual disabilities.

Recent theoretically‐driven models have suggested that care staff causal attributions about challenging behaviours may influence staff intervention behaviour. Previous research on staff attributions has been concerned mainly with institution staff. The present study focused on community staff attributions as compared with those of inexperienced healthcare workers (student nurses). A total sample of 94 participants were asked to rate the likely causes of one of three topographies of challenging behaviour (self‐injury, aggression or stereotypy) using 25 attributional items presented in a questionnaire. Results showed that experienced care staff and inexperienced students differed in their views on likely causes of challenging behaviours, although this was not restricted to a single type of causal factor. The experienced staff as a group rated social and emotional variables as likely causes of challenging behaviours. Finally, both experienced and inexperienced participants distinguished between behavioural topographies in terms of their causes. Stereotypy was viewed as a self‐stimulatory activity, whilst aggression and self‐injury were rated as more likely to be caused by social and emotional factors. The implications of research in this area for staff training and behavioural intervention are outlined. In addition, suggestions for future research are discussed.

AbstractBackgroundLongitudinal research is needed to strengthen evidence for risk factors for challenging behaviour in children with intellectual disabilities and to understand patterns of change over time.MethodsData on challenging behaviour were collected for 225 students in one school over four annual time points and a range of potential risk correlates. Data were analysed using Generalised Estimating Equations.ResultsPrevalence of challenging behaviour, aggression and self‐injury did not vary significantly over time. Stereotyped behaviours increased over the 4‐year period. Challenging behaviour was associated with lower levels of adaptive skills and autism. Stereotyped behaviour increased with age. Self‐injurious behaviour was less likely to be shown in children with profound intellectual disabilities over time.ConclusionsThese findings are consistent with previous research in terms of potential risk factors identified. Implications for schools include proactive interventions for children with intellectual disabilities at high risk; especially those with autism and poorer adaptive skills.

AbstractBackgroundPositive behavioural support (PBS) can be effective in supporting children and young people (CYP) with developmental disabilities. This systematic review focused on describing the components and nine characteristics of PBS that have been used with CYP with developmental disabilities in special education settings, and the evidence for PBS effectiveness in these settings. Additionally, facilitators and barriers to PBS implementation, and experiences of stakeholders, were investigated.MethodSystematic searches followed a registered protocol, and 30 studies were identified, narratively synthesised, and critically appraised.ResultsFrom the 30 studies included, 10 reported the presence of all 9 PBS characteristics, 17 reported on 8 PBS characteristics, and 3 reported on 7 characteristics. Overall, 28 studies demonstrated significant decreases in behaviours that challenge and increases in alternative behaviours, if increasing alternative behaviours was part of the interventions.ConclusionsThere was a lack of evidence on facilitators and barriers, and a lack of qualitative studies exploring experiences of stakeholders with PBS in special education settings. The available evidence suggested that not all studies reported on all PBS characteristics when describing the approach followed. In addition, available evidence suggested that most studies demonstrated effectiveness of PBS regarding the measured outcomes. Implications and future directions are discussed.

AbstractBackgroundPrevious evaluations of community PBS teams have not investigated whether behaviour change is both statistically reliable and clinically significant. Few previous studies have reported quality of life (QoL) and social validity outcomes.MethodThe present authors collected data on 85 people referred to a specialist PBS team. The present authors used a unique set of multiple measures and statistical change metrics to evaluate outcome.ResultsStatistically significant improvements in QoL and health‐related QoL (HRQoL), with medium to large effect sizes, were demonstrated following PBS input. Mean Behaviour Problems Inventory‐Short Form scores reduced from 37.74 (SD = 30.54) at baseline to 12.12 (SD = 12.24) at follow‐up, with a large effect size (d = 0.84). Stakeholders reported valuing the process and outcomes of PBS, findings which support the social validity of PBS for people with developmental disabilities.ConclusionThis study demonstrates successful PBS outcomes in QoL, HRQoL, challenging behaviour and social validity in a community setting.

Background  Hastings, R. P. [American Journal on Mental Retardation (2002) Vol. 107, pp. 455–467] hypothesized that staff negative emotional reactions to challenging behaviour might accumulate over time to affect staff well‐being. Only one previous study (Mitchell, G.& Hastings, R. P. [American Journal on Mental Retardation (2001) Vol. 106, pp. 448–459] has explored this relationship. The present analyses were designed to replicate these findings.Methods  Data were analysed from two samples of staff. In study 1, 101 staff rated their typical emotional reactions to challenging behaviours experienced as a part of their work and completed the Maslach Burnout Inventory (MBI). In study 2, 99 staff rated their negative emotional reactions to written challenging behaviour vignettes and also completed the MBI.Results  In both studies, significant positive correlations were found between negative emotional reactions to challenging behaviour and emotional exhaustion and depersonalization burnout but no association was found with personal accomplishment scores.Conclusions  These findings replicate previous results, but cannot be used to support the putative causal relationship between emotional reactions to challenging behaviour and staff well‐being. Clinical implications of a focus on staff emotional reactions to challenging behaviour are discussed.

Background  The informal staff culture in intellectual disability services has been proposed as a significant factor determining staff perceptions of, and responses towards, challenging behaviours. However, research to date has been exclusively descriptive.Methods  An experimental analogue of one potentially salient aspect of staff informal culture, the causal language used to describe challenging behaviours, was developed. Naïve participants (N = 84 students) rated attributional dimensions and optimism after viewing a video of aggressive behaviour. Participants were exposed to vignettes in which information about the behaviour's controllability and stability was manipulated prior to viewing the video.Results  Controllability and stability manipulations affected later perception of dimensions of causal attributions (e.g. behaviour presented as controllable was rated as caused by factors more likely to be internal to the depicted client), and optimism (e.g. behaviour presented as stable was associated with a less positive perception of potential for change).Conclusion  Staff talk in intellectual disability services, especially language communicating causal information, is likely to affect perceptions of subsequent incidents of challenging behaviours. This may have important implications for the treatment and assessment of challenging behaviour. Further research is needed to replicate and extend the findings of this study and also to contribute to the development of external validity.

AbstractGroup Stepping Stones Triple P (GSSTP), is an evidence‐based intervention for parents of children with intellectual disability that aims to improve child behavioural difficulties. GSSTP was designed to be delivered face‐to‐face, but during the COVID‐19 pandemic some services started delivering it remotely. The evidence base for remote intervention is growing, but few studies have focused on the experiences of practitioners delivering the interventions and the consequences of their service provision. We aimed to explore UK practitioners' experiences of delivering remotely GSSTP. The objectives were to identify the advantages and disadvantages of remote GSSTP, to determine whether adjustments were made to enable delivery, and to assess perceived acceptability. Participants were identified using consecutive sampling from the Triple P UK practitioner network. Eleven practitioners, who had experience of delivering GSSTP remotely and face‐to‐face, reported their experiences in an online survey. Ten participants also took part in semi‐structured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. According to 55% of practitioners, parent attendance had increased with remote delivery, and 73% of practitioners found remote GSSTP equally or more effective than face‐to‐face. Survey findings about managing parent engagement remotely were mixed and building rapport with patients was considered equally or more difficult remotely. The key themes from the thematic analysis were the practitioners' 'sincere enthusiasm' over the advantages of the remote GSSTP provision, the 'person‐centered strategies' that characterised their practice, the emergence of 'remote delivery as the way forward' for parenting services and finally, the 'challenges of remote delivery'. Remote GSSTP was perceived to be acceptable to participants and practitioners; the advantages of remote delivery appeared to outweigh the disadvantages. Practitioners reported strategies to prompt engagement and recreate group interactions in the remote setting that could be integrated in the practice of other group parenting providers.

BackgroundParenting an individual with intellectual and developmental disabilities (IDD) can be challenging, particularly during adulthood. It is important to better understand ways of supporting families as individuals with IDD age. Self‐compassion is a potential internal coping resource for parents, and is strongly linked to positive mental health outcomes, though research has yet to examine it in parents of adults with IDD.MethodThe current study examines the association between self‐compassion and measures of well‐being for 56 parents of adults with IDD.ResultsGreater self‐compassion was related to lower levels of stress and depression, even after accounting for other known stressors, such as economic disadvantage, having a child with an Autism Spectrum Disorder diagnosis, and high parent burden.ConclusionsSelf‐compassion may offer resiliency against these parenting challenges.