Non-pharmacological interventions for challenging behaviours of adults with intellectual disabilities: A meta-analysis.

E Bruinsma,P J Hoekstra,A P Groenman,G M De Kuijper,B J Van Den Hoofdakker,A A De Bildt,M Klaver

doi:10.1111/jir.12736

E Bruinsma, P J Hoekstra + Show 5 more

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https://doi.org/10.1111/jir.12736

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Abstract

BackgroundNon‐pharmacological interventions are recommended for the treatment of challenging behaviours in individuals with intellectual disabilities by clinical guidelines. However, evidence for their effectiveness is ambiguous. The aim of the current meta‐analysis is to update the existing evidence, to investigate long‐term outcome, and to examine whether intervention type, delivery mode, and study design were associated with differences in effectiveness.MethodAn electronic search was conducted using the databases Medline, Eric, PsychINFO and Cinahl. Studies with experimental or quasi‐experimental designs were included. We performed an overall random‐effect meta‐analysis and subgroup analyses.ResultsWe found a significant moderate overall effect of non‐pharmacological interventions on challenging behaviours (d = 0.573, 95% CI [0.352–0.795]), and this effect appears to be longlasting. Interventions combining mindfulness and behavioural techniques showed to be more effective than other interventions. However, this result should be interpreted with care due to possible overestimation of the subgroup analysis. No differences in effectiveness were found across assessment times, delivery modes or study designs.ConclusionsNon‐pharmacological interventions appear to be moderately effective on the short and long term in reducing challenging behaviours in adults with intellectual disabilities.

Highlights

IntroductionStudies with larger adult sample sizes and (randomised) control groups have been published (Hassiotis et al, 2018; MacDonald, McGill, & Murphey, 2018; McGill et al, 2018; Singh et al, 2018)
Non-pharmacological interventions for challenging behaviours of adults with intellectual disabilities are being recommended as first line treatments by several leading clinical guidelines (Banks & Bush, 2016; National Institute for Health and Care Excellence, 2017; Sullivan et al, 2018)
E-mail address: (e-mail: e.bruinsma@umcg.nl) behavioural techniques showed to be more effective than other interventions. This result should be interpreted with care due to possible overestimation of the subgroup analysis

Summary

Introduction

Studies with larger adult sample sizes and (randomised) control groups have been published (Hassiotis et al, 2018; MacDonald, McGill, & Murphey, 2018; McGill et al, 2018; Singh et al, 2018) These studies have not yet been included in the most recent meta-analysis (Knotter et al, 2018), which found that staff training does not reduce challenging behaviours of individuals with intellectual disabilities. Non-pharmacological interventions are recommended for the treatment of challenging behaviours in individuals with intellectual disabilities by clinical guidelines. We performed an overall random-effect meta-analysis and subgroup analyses

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