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AbstractStaff beliefs about challenging behaviours, and their perception of their working environment, are important for two main reasons. Firstly, the manner in which staff define challenging behaviour affects who is labelled as a challenge, and who is referred to specialist services. Secondly, staff views of their working environment may help us to understand why staff interact with people with learning disabilities in the apparently counter‐habilitative ways outlined in previous reasearch. These issues were investigated in a systematic semi‐structured interview of 19 care staff. The interview covered staff definitions of challenging behaviour, the reasons for its occurrence, and strategies for its amelioration; their views on training and behavioural programmes; and their reported emotional responses to challenging behaviour. Content analysis of the interview transcripts revealed several patterns that may help in generating an account of staff behaviour. For example, staff's beliefs about the causes of challenging behaviour were partially congruent with those of psychological analyses, but their reported interventions for challenging behaviour could not be characterised as 'functional' strategies. Staff reports also revealed some of the factors in the service environment that may explain why they respond 'inappropriately' to challenging behaviour in the short term. These included: an emphasis in staff training on techniques for managing behaviour rather than understanding it, the (possibly resulting) belief that challenging behaviour is to be controlled, and the aversive nature of challenging behaviours. These findings, and their implications for research and practice, are discussed.

Background  Previous research has identified various dimensions of social support that are positively associated with parental well‐being. However, most research does not include multiple measures of social support and uses heterogeneous samples in terms of child characteristics such as age and severity of intellectual disability.Methods  Thirty‐three parents of adolescent children with moderate–profound intellectual disabilities completed measures of parental well‐being (stress, anxiety and depression, and caregiving satisfaction), social support (informal and formal sources, and practical and emotional support), and child characteristics (adaptive and problem behaviours).Results  Correlation analyses showed that parental well‐being was associated with the child's adaptive and problem behaviours and with the child's autism diagnosis. Parents' ratings of the helpfulness of informal sources of support (spouse, extended family, friends, etc.) was most reliably associated with parental well‐being, and remained so after controlling for child characteristics. Parents' access of service and professional support was not associated with parental well‐being, but there was some evidence that it was related to their child's needs.Conclusions  The research emphasizes the significance of including multiple measures of social support in research with families of children with an intellectual disability. Furthermore, the possibility that parents, during their child's adolescence, may be especially vulnerable to the disruption of their informal support networks is an important practical consideration.

Behavior analysts have had a significant impact on the analysis and intervention of challenging behaviors in persons with developmental disabilities. These successes are celebrated in the first part of this article. In the remainder of the article, we present a selective discussion of three issues that we hope will help to further stimulate work with challenging behaviors: (a) the development of challenging behaviors, (b) the role of rule-governance in challenging behavior, and (c) the behavior of persons (mediators) who directly apply functional assessment and intervention technologies. Each of these issues is discussed and implications are drawn for future reseach and practice in the field. In drawing some conclusions, we focus on the internal and external validity of functional assessment and interventions.

AbstractThe terms used to denote the concepts of mental handicap and challenging behaviour are a matter of continuing controversy. In the first part of this paper, research concerned with evaluating the impact of such labels is reviewed, and the value of a semantic technique for assessing the connotative effect of labels is proposed. In the second part, this approach was evaluated in a study in which undergraduate social science and science students completed rating scales for terms currently in use to describe mental handicap and challenging behaviour. There were marked differences in the connotations of terms with very similar denotations. Specifically, recently coined terms (e.g. 'learning difficulty', 'challenging behaviour') were rated more favourably than more familiar descriptions (e.g. 'mental retardation', 'problem behaviour'). Nevertheless, virtually all the terms assessed carried negative, rather than neutral or positive, connotations. These results are discussed in terms of the need to devise descriptions that will promote more positive social representations of mental handicap.

Research and theory on behaviour problems in children with intellectual disabilities (IDs) have tended to focus on maintaining variables and present correlates of disorder. The present study focused on potential early correlates of behavioural problems. The parents of 188 children attending schools for those with 'severe learning difficulties' completed the Developmental Behaviour Checklist (DBC), and a questionnaire asking for demographic details and information about present and early correlates (i.e. epilepsy and physical ability, and early developmental progress, early feeding problems and obstetric complications). Hierarchical regression analyses were performed to explore whether potential early correlates from infancy could add to the prediction of behaviour problems from established correlates and diagnostic variables. Potential early correlates across all of the DBC domains did not add significantly to the prediction of behaviour problems. However, there were effects of sex, physical ability and diagnostic categories. A number of methodological factors (i.e. poor response rate, focus only on severe ID and retrospective data collection) are discussed in terms of how they impact on the results. However, analyses of large samples such as that reported in the present study may still provide a useful addition to research on the early development of behaviour problems. Such data may help in the identification of children at risk who may benefit from early intervention.

AbstractBackgroundExisting research has predominately focused on dyadic relationships in families of children with intellectual disabilities. The aim of this study was to build on emerging literature exploring triadic relationships between a mother, sibling, and child with intellectual disability, investigating how they influence each other's well‐being.MethodAn online survey was used to collect information regarding the mother's mental health and the emotional and behavioural problems of the sibling and the child with intellectual disability in 573 families.ResultsUsing structural equation modelling, we found that maternal psychological distress was associated with higher levels of behaviour problems in the sibling, and the behaviour problems of the child with intellectual disability were associated with higher levels of maternal distress.ConclusionsFamily member well‐being is inter‐related in families of children with intellectual disabilities. Clinical interventions that improve the behaviours of children with intellectual disabilities should be considered.

Background  A range of factors have been suggested as determinants of staff behaviour in the context of working with people with challenging behaviour. The purpose of this study was to evaluate whether a typical challenging behaviour staff training course had an effect on staff feelings of efficacy, their negative emotional reactions to challenging behaviour, and their causal beliefs.Methods  Forty‐eight staff attending a 3‐day training course on understanding challenging behaviour and managing stress were assessed pre‐training and at a 3‐month follow‐up. Questionnaires assessing self‐efficacy, emotional reactions and causal beliefs were used.Results  Perceived self‐efficacy in dealing with challenging behaviours increased significantly from pre‐ to post‐training. There were no significant changes in either emotional reactions to challenging behaviours or causal beliefs.Conclusion  In common with previous research, there was a sizeable impact on staff confidence and efficacy after a 3‐day training course. Given the potential significance of emotional reactions both in terms of staff behaviour and their psychological well‐being at work, more research is needed to explore how these reactions might best be dealt with in staff training interventions.

Background  There is a high rate of physical violence in populations with intellectual disabilities, and this has been linked to problems for the victim, the assailant, members of staff and services. Despite the clinical significance of this behaviour, few studies have assessed methods of predicting its occurrence. The present study examined clinical and actuarial methods of predicting violence in a forensic intellectual disability hospital.Methods  The sample for the study consisted of people resident in the hospital during a 1‐year period (n = 124). Clinical prediction used a risk rating made by members of the person's clinical team, whereas actuarial prediction used the number of violent incidents in the 6‐months before the date of the clinical risk assessment. Computerized hospital records of violence in the 6 months after the assessment were used to examine the predictive accuracy of the two methods.Results  The clinical method produced an area under the curve of 0.74 (95% CI: 0.65–0.83) in a receiver–operating characteristic curve analysis. The value for the actuarial method was 0.77 (95% CI: 0.69–0.86). Both methods performed at levels significantly above chance, but no one method was found to be superior to the other.Conclusions  These findings suggest that it is possible to predict who is at risk of violence in forensic populations with intellectual disabilities. Here, the authors discuss the clinical implications of these findings and the clinical application of risk prediction within clinical services.

Background  Although grandparents are recognized as an important source of support for families of children with intellectual and other disabilities, there has been very little research in this area. The aim of the present paper is to present a brief overview of the literature, and to present data from a preliminary study of relationships between parental stress and grandparent support and conflict.Methods  Sixty‐one parents of children with Down's syndrome (34 mothers and 27 fathers) completed questionnaires on grandparent support and conflict. Parents also completed the Friedrich Short Form of the Questionnaire on Resources and Stress (QRS) with scoring amended to include a depression sub‐scale.Results  The main findings were: (1) grandparent support and conflict were associated with mothers' but not fathers' ratings of stress on the QRS, and (2) both grandparent support and conflict made independent contributions to the prediction of mothers' stress on at least one dimension of the QRS.Conclusions  Practical implications of the results for interventions designed to encourage grandparent support for families are discussed. Issues for further research and methodological problems with the study are also identified.

AbstractBackgroundEarly intervention (EI) can improve a range of outcomes for families of children with developmental disabilities. However, research indicates the level of access does not always match the level of need. To address disparities, it is essential to identify factors influencing access.MethodWe propose a framework where access to EI is conceptualised as a process that includes three main phases. A narrative review examined potential barriers, facilitators and modifiers of access for each phase.ResultsThe process of access to EI includes the following: 1) recognition of need, 2) identification or diagnosis and 3) EI provision or receipt. Several factors affecting access to EI for each phase were identified, related to the family, services, the intersection between family and services, and the context.ConclusionA broad range of factors appear to influence the process of access to EI for this population. Our framework can be used in future research investigating access. Broad implications for policy, practice and future research to improve access to EI are discussed.

BackgroundProviding long‐term care to an adult relative with intellectual disability can impact negatively on caregivers' health and well‐being.MethodsData were collected via online and postal questionnaires on 110 family carers' physical and psychological health, family stress and perceived positive gains from caring. Psychological adaptation and carers' satisfaction with available support were also examined.ResultsStudy participants reported more health problems than general populations. Higher support needs of care recipients were associated with increased family stress. Carers being female were associated with lower family stress. Older age and better socio‐economic position were associated with better psychological outcomes. Other associations were consistent with psychological adaption and perceived helpfulness of support buffering negative outcomes and facilitating positive gains from caring.ConclusionsFamily carers of adults with intellectual disability appear to experience poorer health outcome than population norms. Adaption to the caregiving role may buffer negative outcomes. Further large scale, population‐based, longitudinal research is needed.

BackgroundThe field of forensic intellectual disabilities has been developing rapidly over the last 15 years. Much of the work has been built on research in mainstream criminality but more recently studies have emerged that reveal issues specific to offenders with intellectual disability.MethodResearch on pathways into offending is reviewed with reference to its relevance to the field of intellectual disability. We also summarize some findings on pathways into and through services for offenders with intellectual disability.FindingsStudies reveal that developmental adversity is an important risk variable. Previous and recent aggression are potent risk factors. New evidence suggests that immediate, proximal risk factors may be more important in this client group. The studies in this issue add to the knowledge on pathways into offending, important areas for assessment and effective treatments as well as advancing knowledge in the academic literature on general criminality.

Background  Although interventions for children with pervasive developmental disorders (PDD) have been the focus of research effort and evidence reviews in many Western countries, this evidence has not been assessed in the context of low‐ and middle‐income (LAMI) countries especially in terms of the fit with different cultures and resources.Method  As a part of the WHO MH‐GAP project, we carried out a systematic review of published literature relating to interventions for PDD in LAMI countries. Given the small amount of direct evidence found, we supplemented the review with findings from existing relevant evidence reviews to draw practical recommendations.Results  We found only four controlled studies evaluating an intervention for children with PDD in a LAMI country. These studies all evaluated different interventions. A systematic search of controlled studies of evidence‐based parenting training interventions (Incredible Years and Triple P) in non‐LAMI countries identified two studies both indicating successful outcomes.Conclusions  The evidence base for interventions for PDDs in LAMI countries is sparse, and to inform practical and future research recommendations, it is important to consider potentially deliverable behavioural parent training interventions. Such interventions need to be explored in LAMI countries when delivered in primary and secondary healthcare contexts.

Background  Previous research with mothers of children with intellectual disabilities has shown that psychological acceptance is related to maternal psychological well‐being. The present research extended this line of enquiry to fathers and explored the potential for psychological acceptance to mediate the impact of children's behaviour problems on paternal well‐being.Method  Ninety‐nine fathers of 67 boys and 32 girls with intellectual disability, between 6 and 18 years of age, participated in a questionnaire study. Psychological acceptance of difficult/negative emotions and thoughts associated with interactions with the child with intellectual disability were measured alongside ratings of the child's behaviour problems and paternal negative (stress, anxiety, depression) and positive ('positive gain') well‐being.Results  Psychological acceptance was found to partially mediate the impact of child behaviour problems on paternal stress, anxiety, and depression. Acceptance was also a positive predictor of fathers' perceptions of positive gain associated with raising their child with intellectual disability. However, it could not function as a potential mediator of positive gain in the present research because fathers' ratings of their child's behaviour problems were not associated with paternal positive gain.Conclusions  Implications for practice include the potential of acceptance‐based interventions, and other psychological interventions targeting acceptance and avoidance processes (e.g. mindfulness‐based approaches), to positively affect paternal psychological adjustment.